Provider Demographics
NPI:1871724658
Name:JOHNSTON, MARIANNE STEWART (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MARIANNE
Middle Name:STEWART
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 826
Mailing Address - Street 2:
Mailing Address - City:BLACK DIAMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98010-0826
Mailing Address - Country:US
Mailing Address - Phone:425-235-9614
Mailing Address - Fax:425-235-1060
Practice Address - Street 1:17900 TALBOT RD S
Practice Address - Street 2:SUITE 101
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-8212
Practice Address - Country:US
Practice Address - Phone:425-235-9614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA 60105502363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant