Individual
JERALD JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1618 E GATEWAY CIR S, APT 301, FARGO, ND 58103-3657
(612) 384-0964
Mailing address
1618 E GATEWAY CIR S, APT 301, FARGO, ND 58103-3657
(612) 384-0964
Taxonomy
Speciality
Code
Description
License number
State
246RM2200X
Medical Laboratory Technician
Primary
04200308
MN
Other
Enumeration date
07/14/2015
Last updated
07/14/2015
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