Individual
JOHNSON CHESTER DOE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5523 102ND AVE N, BROOKLYN PARK, MN 55443-2074
(763) 639-2890
Mailing address
5523 102ND AVE N, BROOKLYN PARK, MN 55443-2074
(763) 639-2890
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Enumeration date
06/25/2021
Last updated
06/25/2021
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