Individual
MRS. ELYSSA MARIE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
701 W OAK ST, FRACKVILLE, PA 17931-1672
(570) 874-4100
Mailing address
100 N ACADEMY AVE, CREDENTIAL DEPT, DANVILLE, PA 17822-4903
(570) 271-6144
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA055747
PA
Other
Enumeration date
10/01/2012
Last updated
08/17/2020
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