Healthcare Provider Details

I. General information

NPI: 1427906155
Provider Name (Legal Business Name): JANELLE LORRAINE GORG JOHNSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2026
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 BROADWAY ST NE STE 500
MINNEAPOLIS MN
55413-2197
US

IV. Provider business mailing address

3001 BROADWAY ST NE STE 500
MINNEAPOLIS MN
55413-2197
US

V. Phone/Fax

Practice location:
  • Phone: 612-871-1145
  • Fax:
Mailing address:
  • Phone: 612-871-1145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number1450361
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: