Individual
MRS. MALISSA MARIE JOHNSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
22 BRAMHALL ST, PORTLAND, ME 04102-3175
(207) 662-0111
Mailing address
6 HARRISON CT, YARMOUTH, ME 04096-1543
(503) 739-5900
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA203035
ME
Other
Enumeration date
04/29/2013
Last updated
09/14/2020
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