Individual
MS. JACQUELYN LEE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.N.P.
Contact information
Practice address
811 2ND ST SE, SUITE A, LITTLE FALLS, MN 56345-3559
(320) 631-7000
(320) 632-0534
Mailing address
811 2ND ST SE, SUITE A, LITTLE FALLS, MN 56345-3559
(320) 631-7000
(320) 632-0534
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R108719-0
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0107328
MEDICA
—
05
—
044997100
—
MN
01
—
140376C736
UCARE MINNESOTA
MN
01
—
47G13JO
BCBS OF MINNESOTA
MN
01
—
A024
TRICARE
MN
01
—
HP33899
HEALTH PARTNERS
—
01
—
NA9231028468
PREFERRED ONE
—
Enumeration date
07/12/2006
Last updated
02/16/2015
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