Healthcare Provider Details

I. General information

NPI: 1366051690
Provider Name (Legal Business Name): BRIANNA KRISTINE JOHNSON DNP, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 ANNE ST NW
BEMIDJI MN
56601-5113
US

IV. Provider business mailing address

1217 ANNE ST NW
BEMIDJI MN
56601-5113
US

V. Phone/Fax

Practice location:
  • Phone: 218-755-6360
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101.0134573
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: