Individual provider · Type 1 NPI

Mallory Johnson, PEDIATRIC NP

Pediatric Nurse Practitioner · Portland, OR

NPI number 1265699508 Active

Practice location

11790 SW Barnes Rd. Blg A, Ste 140
Portland, OR 97225

Call (503) 643-2100 Map

Fax (503) 643-7300

Specialties and licenses

TaxonomyCodeLicense
Pediatric Nurse Practitioner Primary 363LP0200X200850163NP (OR)

Pediatric Nurse Practitioner: Definition to come...

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About NPI 1265699508

Mallory Johnson, PEDIATRIC NP's National Provider Identifier is 1265699508, issued on May 22, 2008. The primary taxonomy on file is Pediatric Nurse Practitioner (363LP0200X), and the practice location is in Portland, OR. The record was last updated on Oct 18, 2021.