Johnson, Marisa Protasel
Johnson, Marisa Protasel is an sole proprietor health care provider with primary practice located at 12360 E Burnside St , Portland OR 97233-1042. She recently has 3 registered licenses in different health care specialties including Nursing Service Providers / Registered Nurse, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health. Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health is her primary health care specialty. Johnson, Marisa Protasel can be contacted via phone (971) 279-4800.Contact Information
Primary practice address
12360 E Burnside St
Portland OR 97233-1042
Phone: (971) 279-4800
Fax: (971) 279-2051
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Nursing Service Providers / Registered Nurse | 163W00000X | RN60200108 | Washington |
| Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner | 363L00000X | AP61312604 | Washington |
| Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health | 363LP0808X | 209.021409 | Illinois |
| Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health | 363LP0808X | 202208550NP-PP | Oregon |
| Nursing Service Providers / Registered Nurse | 163W00000X | 202208453RN | Oregon |
| Nursing Service Providers / Registered Nurse | 163W00000X | 041495198 | Illinois |
Profile Details
| NPI number | 1699011767 |
|---|---|
| LBN Legal business name | Johnson, Marisa Protasel |
| Credentials | PMHNP-BC |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Dec 18th, 2012 |
| Last updated | Mar 21st, 2024 - about 2 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 | 1699011767 | NPPES |
| Oregon | MEDICAID | 500819896 |
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