Healthcare Provider Details

I. General information

NPI: 1700617529
Provider Name (Legal Business Name): JOHANNA CHRISTENSEN DNP FNP-BC PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 WASHINGTON AVE STE A
DETROIT LAKES MN
56501-3906
US

IV. Provider business mailing address

912 MCKINLEY AVE # 311
DETROIT LAKES MN
56501-3504
US

V. Phone/Fax

Practice location:
  • Phone: 218-845-3535
  • Fax: 218-210-9420
Mailing address:
  • Phone: 218-845-3535
  • Fax: 218-210-9420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR33762
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN-5102
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR33762
License Number StateND
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11690
License Number StateMN
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11690
License Number StateMN
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-5102
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: