Healthcare Provider Details

I. General information

NPI: 1558280685
Provider Name (Legal Business Name): SYDNEY MARTHA JOHNSON-HOLT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

720 WASHINGTON AVE SE STE 200
MINNEAPOLIS MN
55414-2924
US

IV. Provider business mailing address

5173 YUMA LN N
PLYMOUTH MN
55446-2015
US

V. Phone/Fax

Practice location:
  • Phone: 612-884-0600
  • Fax:
Mailing address:
  • Phone: 763-331-4382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2483004
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: