Individual
NIKOLENE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
512 S 28TH AVE, WAUSAU, WI 54401-4147
(715) 847-2021
Mailing address
7920 OLD CEDAR AVE S, BLOOMINGTON, MN 55425-1207
(651) 241-1800
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1104363993
—
363A00000X
Physician Assistant
—
MN
363AM0700X
Medical Physician Assistant
—
—
Other
Enumeration date
01/31/2017
Last updated
11/05/2024
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