Individual
JEAN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10467 93RD AVE N, MAPLE GROVE, MN 55369-4112
(651) 488-4655
(651) 488-4656
Mailing address
10467 93RD AVE N, MAPLE GROVE, MN 55369-4112
(651) 488-4655
(651) 488-4656
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R-135491-7
MN
Other
Enumeration date
10/23/2019
Last updated
10/23/2019
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