Healthcare Provider Details

I. General information

NPI: 1144133539
Provider Name (Legal Business Name): HANNAH JANE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HANNAH JANE PROKOSCH

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 RAILROAD AVE
ALBANY MN
56307-9379
US

IV. Provider business mailing address

1130 COUNTY ROAD 4 APT 301
SAINT CLOUD MN
56303-6001
US

V. Phone/Fax

Practice location:
  • Phone: 320-845-2157
  • Fax:
Mailing address:
  • Phone: 320-310-6033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14877
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: