Healthcare Provider Details

I. General information

NPI: 1508345398
Provider Name (Legal Business Name): LAURA ELIZABETH HUFF-JOHNSON DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2277 HIGHWAY 36 W
ROSEVILLE MN
55113-3804
US

IV. Provider business mailing address

15940 EAGLE ST NW
ANDOVER MN
55304-2667
US

V. Phone/Fax

Practice location:
  • Phone: 612-255-0628
  • Fax:
Mailing address:
  • Phone: 126-695-0931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11034505
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number6137
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: