Individual
MARISSA LYNN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1215 E COURT ST, SEGUIN, TX 78155-5129
(830) 379-5867
(830) 401-4035
Mailing address
1215 E COURT ST, SEGUIN, TX 78155-5129
(830) 379-5867
(830) 401-4035
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
TBN573224
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
178028300
DOL
—
05
—
312189901
—
TX
01
—
8554UD
BCBS
TX
Enumeration date
02/28/2006
Last updated
10/24/2013
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