Individual
NICHOLAS ROY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
14500 99TH AVE N, MAPLE GROVE, MN 55369-4730
(763) 898-1000
(763) 898-1009
Mailing address
11111 ANDERSON LAKES PKWY, EDEN PRAIRIE, MN 55344-4145
(952) 451-3906
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
14147
MN
Other
Enumeration date
08/09/2022
Last updated
10/13/2022
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