Individual
MISS MACKENZIE SUE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
106 NORTH 4TH AVENUE, FERGUS FALLS, MN 56537-1034
(218) 998-3778
(218) 998-3187
Mailing address
4240 17TH AVE S, # 9, FARGO, ND 58103-3353
(218) 790-3692
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
L0646244
MN
164W00000X
Licensed Practical Nurse
L11671
ND
Other
Enumeration date
07/06/2007
Last updated
07/08/2007
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