Individual
MS. BRIANNE LYNN JOHNSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
55 FRUIT ST., YAWKEY 2C, BOSTON, MA 02114
(617) 726-7938
Mailing address
55 FRUIT ST., BOSTON, MA 02114-2696
(617) 726-7938
(401) 854-2519
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
4181
MA
363AM0700X
Medical Physician Assistant
1215
TN
363AM0700X
Medical Physician Assistant
Primary
PA00441
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01/15/2008
NHPRI
RI
05
—
1275558
—
RI
01
—
1275558652
NPI
—
01
—
33070-7
BLUECHIP
RI
01
—
414337
BCBSRI
RI
01
—
939025129
RI MEDICARE GROUP NUMBER
RI
01
—
979005636
MEDICARE
RI
Enumeration date
07/13/2006
Last updated
01/31/2019
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