Mallory Johnson, Pediatric NP
Nurse Practitioner, Pediatrics in Portland, OR. Individual provider (NPI-1).
NPI number1265699508
StatusActive
Last updated in NPPESOct 18, 2021
Details
- NPI
- 1265699508
- Entity type
- Individual (NPI-1)
- Name
- Ms. Mallory Johnson
- Credential
- Pediatric NP
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- May 22, 2008
- Certification date
- Oct 18, 2021
- Last updated
- Oct 18, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LP0200X | Nurse Practitioner, Pediatrics | 200850163NP | OR | Yes |
Other names
- Mallory Braun (Former Name)
Practice location
11790 Sw Barnes Rd. Blg ASte 140
Portland, OR 97225
Phone 503-643-2100 · Fax 503-643-7300
Mailing address
11790 Sw Barnes Rd. Blg ASte 140
Portland, OR 97225
Phone 503-643-2100 · Fax 503-643-7300
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