Healthcare Provider Details

I. General information

NPI: 1457024168
Provider Name (Legal Business Name): BRIDGET MARIE JOHNSON APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRIDGET MARIE VETSCH

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12800 ROLLING RIDGE RD
BECKER MN
55308-8838
US

IV. Provider business mailing address

1900 CENTRACARE CIR
SAINT CLOUD MN
56303-5000
US

V. Phone/Fax

Practice location:
  • Phone: 763-261-7000
  • Fax:
Mailing address:
  • Phone: 320-240-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8204
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: