Individual
HEATH JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2478 SUNSET LN, BARNUM, MN 55707-8838
(218) 461-0657
Mailing address
2478 SUNSET LN, BARNUM, MN 55707-8838
(218) 461-0657
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
P556144959916
MN
Other
Enumeration date
02/05/2016
Last updated
02/05/2016
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