Healthcare Provider Details

I. General information

NPI: 1346057551
Provider Name (Legal Business Name): DENISE MARY JOHNSTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2024
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3221 32ND AVE S
GRAND FORKS ND
58201-6071
US

IV. Provider business mailing address

3221 32ND AVE S
GRAND FORKS ND
58201-6071
US

V. Phone/Fax

Practice location:
  • Phone: 701-335-4380
  • Fax: 701-772-0324
Mailing address:
  • Phone: 701-335-4380
  • Fax: 701-772-0324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR32770
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: