Individual
NICOLE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
410 W. 4TH ST, MAHNOMEN, MN 56557
(218) 935-2514
Mailing address
47639 192ND ST, BRANDT, SD 57218-5731
(218) 280-1024
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2022003041
SD
Other
Enumeration date
05/26/2022
Last updated
05/26/2022
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