Individual
MARY ALYCIA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6401 FRANCE AVE S, EDINA, MN 55435-2104
(952) 924-5000
Mailing address
6401 FRANCE AVE S, EDINA, MN 55435-2104
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
R1447772
MN
Other
Enumeration date
05/25/2006
Last updated
05/16/2008
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