Individual
MARCIE MARIE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
9155 SW BARNES RD, SUITE 536, PORTLAND, OR 97225-6625
(503) 935-8100
(503) 935-8110
Mailing address
847 NE 19TH AVE, SUITE 300, PORTLAND, OR 97232-2684
(503) 963-2801
(503) 963-2825
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA167463
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5006797037
—
OR
Enumeration date
07/22/2014
Last updated
12/01/2016
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