Healthcare Provider Details

I. General information

NPI: 1619883568
Provider Name (Legal Business Name): PEACE LOVE & HEALTHCARE CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 NICOLLET MALL STE 1235
MINNEAPOLIS MN
55402-2702
US

IV. Provider business mailing address

825 NICOLLET MALL STE 1235
MINNEAPOLIS MN
55402-2702
US

V. Phone/Fax

Practice location:
  • Phone: 612-208-2195
  • Fax:
Mailing address:
  • Phone: 612-208-2195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. JODI JOHNSON
Title or Position: FNP-C
Credential: CNP
Phone: 612-208-2195