Individual
BREONA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2705 HERSCHEL ST N UNIT B205, ROSEVILLE, MN 55113-4491
(952) 228-5080
Mailing address
2705 HERSCHEL ST N UNIT B205, ROSEVILLE, MN 55113-4491
(952) 228-5080
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
11/14/2022
Last updated
11/14/2022
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