Healthcare Provider Details

I. General information

NPI: 1679435887
Provider Name (Legal Business Name): LOWELL JOHNSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2025
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 26
SANDSTONE MN
55072-0026
US

IV. Provider business mailing address

PO BOX 26
SANDSTONE MN
55072-0026
US

V. Phone/Fax

Practice location:
  • Phone: 320-245-5355
  • Fax: 320-245-3140
Mailing address:
  • Phone: 320-245-5355
  • Fax: 320-245-3140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberT860288485514
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: