Individual
KATHERINE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
333 SMITH AVE N STE 4640, SAINT PAUL, MN 55102-2344
(651) 241-1001
(651) 241-1116
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-9000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
45750
MN
207Q00000X
Family Medicine Physician
MD26128
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
840292006
REGENCE
OR
01
—
911019392
COMMERCIAL
—
Enumeration date
09/06/2006
Last updated
12/11/2020
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