Healthcare Provider Details

I. General information

NPI: 1407886559
Provider Name (Legal Business Name): MARJORIE JOHNSON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 06/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7440 SPRING VILLAGE DR
SPRINGFIELD VA
22150-4446
US

IV. Provider business mailing address

701 MAIDEN CHOICE LN
CATONSVILLE MD
21228-5968
US

V. Phone/Fax

Practice location:
  • Phone: 703-923-4644
  • Fax: 703-923-4625
Mailing address:
  • Phone: 703-923-4644
  • Fax: 703-923-4625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0017001376
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: