Individual
MARISSA IRENE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
450 BROOKLINE AVE, BOSTON, MA 02215-5450
(617) 278-0055
Mailing address
450 BROOKLINE AVE, BOSTON, MA 02215-5450
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9454
MA
363AM0700X
Medical Physician Assistant
PA1616
ME
Other
Enumeration date
07/26/2016
Last updated
06/26/2026
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