Provider Demographics
NPI:1407886559
Name:JOHNSON, MARJORIE (CRNP)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 MAIDEN CHOICE LN
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-5968
Mailing Address - Country:US
Mailing Address - Phone:703-923-4644
Mailing Address - Fax:703-923-4625
Practice Address - Street 1:7440 SPRING VILLAGE DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-4446
Practice Address - Country:US
Practice Address - Phone:703-923-4644
Practice Address - Fax:703-923-4625
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0017001376363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
0016OtherCAREFIRST
8305186OtherEVERCARE
1407886559OtherBCBS-VA
MD64650001OtherBCBS OF MD
MD64650001OtherBCBS OF MD
1407886559OtherBCBS-VA
0016OtherCAREFIRST