Individual
MS. JENNIFER SUSAN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
800 E 28TH ST, MINNEAPOLIS, MN 55404
(612) 871-7639
(612) 872-0302
Mailing address
2828 CHICAGO AVE, STE 300, MINNEAPOLIS, MN 55407
(612) 871-7639
(612) 872-0302
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
CRNA073617
MN
367500000X
Certified Registered Nurse Anesthetist
R1461143
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
421690300
—
MN
01
—
451M9HO
BCBSMN
MN
Enumeration date
02/24/2006
Last updated
03/26/2009
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