Individual
GREGORY M JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN,CNP
Contact information
Practice address
705 PLEASANT AVE S, PARK RAPIDS, MN 56470-1440
(218) 732-2800
(218) 732-2857
Mailing address
1702 UNIVERSITY DR S, FARGO, ND 58103-4940
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R 223267-2
MN
363LP0200X
Pediatric Nurse Practitioner
Primary
3084
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1437554482
—
MN
Enumeration date
11/01/2014
Last updated
02/25/2021
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