Provider Demographics
NPI:1871896894
Name:JOHNSTONE-PETTY, MARIANNE (MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:JOHNSTONE-PETTY
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4105
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4105
Mailing Address - Country:US
Mailing Address - Phone:866-907-1068
Mailing Address - Fax:425-917-9141
Practice Address - Street 1:3200 PROVIDENCE DR
Practice Address - Street 2:SUITE B111
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4615
Practice Address - Country:US
Practice Address - Phone:907-212-7997
Practice Address - Fax:907-212-8225
Is Sole Proprietor?:No
Enumeration Date:2010-12-13
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1189363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1571407Medicaid
AK1730113739OtherPATIENTS FIRST MEDICAL CLINIC LLC - TYPE 2
AKK165277Medicare PIN