Individual
KELLY UNDERBERG JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
400 E 3RD ST, SMDC MEDICAL CENTER-DULUTH CLINIC, DULUTH, MN 55805-1951
(218) 786-3925
Mailing address
400 E 3RD ST, SMDC MEDICAL CENTER-DULUTH CLINIC, DULUTH, MN 55805-1951
(218) 786-3925
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R 114150-2
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114157625
—
MI
05
—
1114157625
—
MN
05
—
1114157625
—
WI
Enumeration date
07/17/2009
Last updated
06/20/2011
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