Healthcare Provider Details

I. General information

NPI: 1447166731
Provider Name (Legal Business Name): KRISTINA MARIE JOHNSON
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1470 INDUSTRIAL DR NW
ROCHESTER MN
55901-0700
US

IV. Provider business mailing address

3936 E FRONTAGE HIGHWAY 52 RD N UNIT 155 PMB 155
ROCHESTER MN
55901-0108
US

V. Phone/Fax

Practice location:
  • Phone: 507-353-3023
  • Fax:
Mailing address:
  • Phone: 734-771-1297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: