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NPI Code Detail

MEDICARE: SARAH MARY JOHNSON FNP-BC

MEDICARE: SARAH MARY JOHNSON FNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LG0600XGerontology Nurse Practitioner970MN

General Provider Information

NPI Number : 1063645224
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARAH MARY JOHNSON FNP-BC
Provider Business Mailing Address
First Line : 6694 MCKOWN CT
Second Line :
City : INDEPENDENCE
State : MN
Zip : 55359-2200
Country : US
Telephone Number : 952-240-4944
Fax Number :
Provider Business Practice Location Address
First Line : 5200 DOUGLAS DR N
Second Line :
City : CRYSTAL
State : MN
Zip : 55429-3104
Country : US
Telephone Number : 763-400-3628
Fax Number : 763-342-4183
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/03/2009
Last Update Date : 12/18/2023

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