Provider Demographics
NPI:1376431874
Name:JOHNSON, MARISSA ANN VIRNIG
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:ANN VIRNIG
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 1:5315 16TH ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-4674
Mailing Address - Country:US
Mailing Address - Phone:320-232-8903
Mailing Address - Fax:
Practice Address - Street 1:1900 CENTRACARE CIR STE 1575
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-229-4944
Practice Address - Fax:320-229-5156
Is Sole Proprietor?:No
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program