Individual
MARY JOHNSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
701 PARK AVE, MINNEAPOLIS, MN 55415-1623
(612) 873-6005
Mailing address
1148 HAGUE AVE, SAINT PAUL, MN 55104-6411
(351) 224-9671
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R132394-8
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01-73347
MEDICA
MN
01
—
171175
UCARE
MN
01
—
209K1JO
BCBS
MN
05
—
233677400
—
MN
01
—
HP32961
HEALTH PARTNERS
MN
01
—
NA9021032953
PREFERRED ONE
MN
Enumeration date
03/29/2006
Last updated
01/25/2016
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