Individual
MARC RAY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8601 W DODGE RD STE 106, OMAHA, NE 68114-3430
(402) 575-5577
Mailing address
5030 MYRTLE ST, LINCOLN, NE 68506-6310
(712) 898-2456
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
115439
NE
Other
Enumeration date
06/24/2024
Last updated
06/24/2024
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