Individual
JACINDA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
512 30TH AVE E STE 100, ALEXANDRIA, MN 56308-5096
(320) 762-5411
Mailing address
891 BELSLY BLVD, MOORHEAD, MN 56560-5055
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
12/26/2017
Last updated
12/26/2017
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