MEDICARE: CLARISSA JOHNSTON DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	2310	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851371579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLARISSA JOHNSTON DO

Provider Business Mailing Address
First Line	:	11416 N. 44TH COURT
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85028-2325
Country	:	US
Telephone Number	:	480-242-7400
Fax Number	:

Provider Business Practice Location Address
First Line	:	11416 N 44TH CT
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85028-2325
Country	:	US
Telephone Number	:	480-242-7400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	12/15/2011

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