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General NPI Number Information
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NPI Number | 1508609587
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Entity Type | Individual
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Provider Name | MARISSA JOHNSON FNP-C
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Gender | Female
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Dates
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Enumeration Date | 06/17/2024
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 510 CAROLINA BAY DR STE 110
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City | WILMINGTON
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State | NC
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Zip | 28403-2046
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Country | US
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Telephone | 910-662-6000
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Fax | 910-550-3787
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Provider Business Mailing Address
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Address Line | 112 MEDICAL VILLAGE DR STE G
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City | WALLACE
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State | NC
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Zip | 28466-1665
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Country | US
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Telephone | 910-552-1580
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Fax | 910-665-1780
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 326265
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License Number State | NC
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