Individual
MR. BLAKE EDWARD JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1017 SELKIRK CIR, GRAND FORKS, ND 58203-4000
(701) 795-9143
Mailing address
930 N 3RD ST, GRAND FORKS, ND 58203-2408
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
04/13/2021
Last updated
04/13/2021
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