Individual
TYLER MICHAEL JOHNSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
14700 28TH AVE N STE 20, PLYMOUTH, MN 55447-4876
(763) 559-3779
(763) 450-3986
Mailing address
PO BOX 47159, PLYMOUTH, MN 55447-0159
(763) 559-3779
(763) 450-3986
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
2662
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/24/2021
Last updated
01/05/2022
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