Individual
MARY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
11611 NE AINSWORTH CIR, PORTLAND, OR 97220-9017
(503) 257-1732
Mailing address
111 NE FLORAL PL, PORTLAND, OR 97232-3407
(503) 317-8494
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
088006646RN
OR
Other
Enumeration date
04/21/2026
Last updated
04/21/2026
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