Individual
DEBRA DEANOVIC JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2220 RIVERSIDE AVE, MAIL STOP 31700A, MINNEAPOLIS, MN 55454-1321
(612) 371-1600
(612) 371-1732
Mailing address
8170 33RD AVE S, BLOOMINGTON, MN 55425-4516
(952) 967-7676
(612) 341-1432
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
26260
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
310382000
—
MN
Enumeration date
02/22/2006
Last updated
02/28/2020
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