Individual
IAN JAMES JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1540 RANDOLPH AVE, SAINT PAUL, MN 55105-2535
(651) 699-8333
Mailing address
1540 RANDOLPH AVE, SAINT PAUL, MN 55105-2535
(651) 699-8333
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/15/2020
Last updated
09/20/2022
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