Individual
STACY ELAINE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3520 42ND ST S APT 304, FARGO, ND 58104-6967
(612) 462-3986
Mailing address
1820 40TH ST S APT 210, FARGO, ND 58103-4469
(501) 420-8479
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Enumeration date
08/20/2024
Last updated
08/20/2024
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