Healthcare Provider Details

I. General information

NPI: 1205661022
Provider Name (Legal Business Name): DANAE ESPERANZA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TAYLOR DANAE RODRIGUEZ

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 JACKSON ST NE STE 100
MINNEAPOLIS MN
55413-3051
US

IV. Provider business mailing address

4312 HAMPSHIRE AVE N
MINNEAPOLIS MN
55428-5252
US

V. Phone/Fax

Practice location:
  • Phone: 612-353-6293
  • Fax:
Mailing address:
  • Phone: 218-731-8785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: