Provider Demographics
NPI:1346620820
Name:JOHNSON, MARNIE
Entity Type:Individual
Prefix:
First Name:MARNIE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13404 E JEWELL AVE
Mailing Address - Street 2:#103
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-5464
Mailing Address - Country:US
Mailing Address - Phone:256-274-7226
Mailing Address - Fax:
Practice Address - Street 1:13404 E JEWELL AVE
Practice Address - Street 2:#103
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-5464
Practice Address - Country:US
Practice Address - Phone:256-274-7226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13109198031163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse