Johnson, Marisa
Johnson, Marisa is an sole proprietor health care provider with primary practice located at 1303 Line Ave Ste 400, Shreveport LA 71101-4628. She recently has only one registered license in Allopathic & Osteopathic Physicians / Nephrology, which is considered as her primary health care specialty. Johnson, Marisa can be contacted via phone (318) 221-2707.Contact Information
Primary practice address
1303 Line Ave Ste 400
Shreveport LA 71101-4628
Phone: (318) 221-2707
Fax: (313) 221-2709
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Nephrology | 207RN0300X | L6967 | Texas |
| Allopathic & Osteopathic Physicians / Nephrology | 207RN0300X | 023908 | Louisiana |
| Allopathic & Osteopathic Physicians / Nephrology | 207RN0300X | MD.023908 | Louisiana |
Profile Details
| NPI number | 1083615520 |
|---|---|
| LBN Legal business name | Johnson, Marisa |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 9th, 2005 |
| Last updated | Sep 6th, 2017 - about 7 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1083615520 | NPPES |
| Texas | MEDICAID | 146986802 | |
| Texas | MEDICAID | 1487481 |
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