Individual
NICOLE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
5707 HIGHWAY 7 APT 107, ST LOUIS PARK, MN 55416-2391
(651) 408-2624
Mailing address
5707 HIGHWAY 7 APT 107, MINNEAPOLIS, MN 55416-2391
(651) 408-2624
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
3297
MN
Other
Enumeration date
12/12/2020
Last updated
12/12/2020
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