Individual
SAMUEL JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1500 CURVE CREST BLVD W, STILLWATER, MN 55082-6040
(651) 439-1234
Mailing address
N2497 STATE ROAD 58, MAUSTON, WI 53948
(678) 200-3731
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2266
MN
363A00000X
Physician Assistant
7270
WI
Other
Enumeration date
05/20/2015
Last updated
08/17/2023
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