Individual
MARI JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
700 E NORWEGIAN ST, POTTSVILLE, PA 17901-2710
(570) 621-4143
Mailing address
1702 MAHANTONGO ST, POTTSVILLE, PA 17901-3225
(570) 628-3677
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN255028L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1372161
HIGHMARK BLUE SHIELD
PA
Enumeration date
08/28/2006
Last updated
07/08/2007
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