Individual
BETH A JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
640 JACKSON ST, SAINT PAUL, MN 55101-2502
(651) 254-4786
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
01074599A
IN
2084P0800X
Psychiatry Physician
Primary
44445
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
328043800
—
MN
Enumeration date
03/17/2006
Last updated
10/25/2024
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