Individual
BROOKE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2450 RIVERSIDE AVE, MINNEAPOLIS, MN 55454-1450
(612) 884-0649
Mailing address
2450 RIVERSIDE AVE, MINNEAPOLIS, MN 55454-1450
(763) 498-1451
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
12341
MN
363A00000X
Physician Assistant
—
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
NY
Other
Enumeration date
12/15/2016
Last updated
10/11/2018
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