Individual
MARY BETH JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
401 E 8TH ST, STE 230, SIOUX FALLS, SD 57103-7011
(605) 334-5099
(605) 333-0245
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
(605) 328-9556
(605) 328-9501
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
CNP0203
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6826094
—
SD
Enumeration date
06/30/2005
Last updated
05/27/2009
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