Individual
MARISSA IRENE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
489 STATE ST, BANGOR, ME 04401-6616
(207) 973-7000
Mailing address
43 WHITING HILL RD STE 300, BREWER, ME 04412-1006
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
07/19/2023
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