Individual
MS. MALLORY JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PEDIATRIC NP
Contact information
Practice address
11790 SW BARNES RD. BLG A, STE 140, PORTLAND, OR 97225
(503) 643-2100
(503) 643-7300
Mailing address
11790 SW BARNES RD. BLG A, STE 140, PORTLAND, OR 97225
(503) 643-2100
(503) 643-7300
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
200850163NP
OR
Other
Enumeration date
05/22/2008
Last updated
10/18/2021
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