Individual
RANDY W JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
736 BROADWAY N, FARGO, ND 58102-4421
(701) 200-0718
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R32408
ND
363LA2100X
Acute Care Nurse Practitioner
R32408
ND
Other
Enumeration date
06/21/2019
Last updated
11/17/2022
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