Healthcare Provider Details

I. General information

NPI: 1457024168
Provider Name (Legal Business Name): BRIDGET MARIE JOHNSON APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRIDGET MARIE VETSCH

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 SMITH AVE N STE 700
SAINT PAUL MN
55102-2972
US

IV. Provider business mailing address

2925 CHICAGO AVE
MINNEAPOLIS MN
55407-1321
US

V. Phone/Fax

Practice location:
  • Phone: 651-241-6600
  • Fax:
Mailing address:
  • Phone: 612-262-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2053741
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: