Individual
THOMAS JOHNSON III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
APRN, CNP
Contact information
Practice address
516 S POKEGAMA AVE, GRAND RAPIDS, MN 55744-3820
(218) 327-2001
(218) 302-1457
Mailing address
516 S POKEGAMA AVE, GRAND RAPIDS, MN 55744-3820
(218) 302-4468
(218) 302-1457
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R 179591-6
MN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2950
MN
Other
Enumeration date
01/03/2008
Last updated
11/29/2023
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