Healthcare Provider Details

I. General information

NPI: 1417288945
Provider Name (Legal Business Name): AMANDA KAY JOHNSON CSA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2010
Last Update Date: 01/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W CENTER ST EI-01 SURGICAL ASSISTANT
ROCHESTER MN
55902-3003
US

IV. Provider business mailing address

114 W. MAIN ST. PO BOX 54
DODGE CENTER MN
55927
US

V. Phone/Fax

Practice location:
  • Phone: 507-266-2827
  • Fax: 507-266-1978
Mailing address:
  • Phone: 507-374-2335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: