Individual provider Active NPI

Marie Therese Johnson, M.S.N., F.N.P.-BC

  • Family Nurse Practitioner
  • Phoenix, AZ
National Provider Identifier
1639226483
Registry record updated Jul 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP8806 Issued in AZ
Practice address
3536 W Glendale Ave
Phoenix, AZ 85051-8395
Phone
(480) 618-0177
Fax
(620) 371-2243
NPI assigned
Jan 4, 2007
Last updated
Jul 22, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AP8806 AZ Primary

Addresses

Primary practice location

3536 W Glendale Ave
Phoenix, AZ 85051-8395

Mailing address

PO Box 746093
Atlanta, GA 30374-6093
Phone (773) 352-1515

Other practice location 1

1661 E Camelback Rd Ste 270
Phoenix, AZ 85016-3922
Phone (888) 777-1945

Other practice location 2

18555 N 79th Ave
Suite D101
Glendale, AZ 85308-8370
Phone (480) 245-6169

Other practice location 3

14668 N Del Webb Blvd
Sun City, AZ 85351-2137
Phone (888) 771-1945

Other practice location 4

1910 S Stapley Dr Ste 130
Mesa, AZ 85204-6677
Phone (888) 777-1945

Other identifiers 1

IdentifierTypeStateIssuer
3434247MedicaidMI

Other names 1

  • Mrs. Marie Therese Demello Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170227002117 AZ Practitioner - Nurse Practitioner 3678857273 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP8806AZMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Infusion Management, Inc. CurrentSince Jul 9, 2022 Accepting new patients
Infusion Management, Inc. CurrentSince Aug 28, 2022 Accepting new patients
Oak Street Health Physicians Group of Arizona PLLC Family PastSince Jul 17, 2021 Accepting new patients
Infusion Management, Inc. PastSince Aug 28, 2022 Accepting new patients

Locations

1910 S Stapley Dr
Ste 130
Mesa, AZ 85204

1661 E Camelback Rd
Ste 270
Phoenix, AZ 85016

14668 N Del Webb Blvd
Sun City, AZ 85351
Phone (888) 771-1945

135 S State College Blvd
Ste 350
Brea, CA 92821

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784678400000",
    "number": "1639226483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746093",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746093",
            "telephone_number": "773-352-1515",
            "fax_number": "321-929-0373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3536 W GLENDALE AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850518395",
            "telephone_number": "480-618-0177",
            "fax_number": "620-371-2243"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1661 E Camelback Rd Ste 270",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850163922",
            "country_code": "US",
            "telephone_number": "888-777-1945",
            "fax_number": "805-413-9099",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "18555 N 79th Ave",
            "address_2": "Suite D101",
            "address_purpose": "LOCATION",
            "city": "Glendale",
            "state": "AZ",
            "postal_code": "853088370",
            "country_code": "US",
            "telephone_number": "480-245-6169",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "14668 N Del Webb Blvd",
            "address_purpose": "LOCATION",
            "city": "Sun City",
            "state": "AZ",
            "postal_code": "853512137",
            "country_code": "US",
            "telephone_number": "888-771-1945",
            "fax_number": "805-413-9099",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1910 S Stapley Dr Ste 130",
            "address_purpose": "LOCATION",
            "city": "Mesa",
            "state": "AZ",
            "postal_code": "852046677",
            "country_code": "US",
            "telephone_number": "888-777-1945",
            "fax_number": "805-413-9099",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MARIE",
        "middle_name": "THERESE",
        "name_prefix": "Mrs.",
        "credential": "M.S.N., F.N.P.-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-04",
        "last_updated": "2026-07-22",
        "certification_date": "2026-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "AP8806",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3434247",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARIE",
            "last_name": "DEMELLO",
            "middle_name": "THERESE",
            "prefix": "MRS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.