Individual
MRS. MARISA PROTASEL JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
12360 E BURNSIDE ST, PORTLAND, OR 97233-1042
(971) 279-4800
(971) 279-2051
Mailing address
1776 SW MADISON ST, PORTLAND, OR 97205-1715
(503) 224-1044
(503) 621-2235
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041495198
IL
163W00000X
Registered Nurse
202208453RN
OR
163W00000X
Registered Nurse
RN60200108
WA
363L00000X
Nurse Practitioner
AP61312604
WA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
202208550NP-PP
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
209.021409
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500819896
—
OR
Enumeration date
12/18/2012
Last updated
03/21/2024
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