Individual
STACY LYNN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
420 CTY RD. 26, BEULAH, ND 58523
(701) 873-6788
Mailing address
204 MAIN ST W, GOLDEN VALLEY, ND 58541-7131
(701) 870-0693
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R34077
ND
Other
Enumeration date
07/22/2013
Last updated
07/22/2013
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