Provider Demographics
NPI:1376560193
Name:JOHNSON, MARYANN (NP)
Entity Type:Individual
Prefix:
First Name:MARYANN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10254 WALLWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20111-4301
Mailing Address - Country:US
Mailing Address - Phone:703-257-9288
Mailing Address - Fax:703-369-1842
Practice Address - Street 1:10696 B CRESTWOOD DRIVE
Practice Address - Street 2:DR. GRACE J. STONEROCK
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-4411
Practice Address - Country:US
Practice Address - Phone:703-368-7110
Practice Address - Fax:703-369-1842
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024085871363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health