Individual
LEOLA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, CNS
Contact information
Practice address
1900 SILVER LAKE RD NW, SUITE 110, NEW BRIGHTON, MN 55112-1786
(651) 628-9566
(651) 628-0411
Mailing address
13021 EVERGREEN DR, BAXTER, MN 56425-7439
(218) 829-9307
(218) 829-7649
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
0917
MN
Other
Enumeration date
08/21/2013
Last updated
01/29/2016
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