Individual
CLARISSA JOHNSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
11416 N 44TH CT, PHOENIX, AZ 85028-2325
(480) 242-7400
Mailing address
11416 N. 44TH COURT, PHOENIX, AZ 85028-2325
(480) 242-7400
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2310
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
270223
—
AZ
Enumeration date
01/19/2006
Last updated
12/15/2011
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