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General NPI Number Information
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NPI Number | 1063645224
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Entity Type | Individual
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Provider Name | SARAH MARY JOHNSON FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/03/2009
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Last Update Date | 12/18/2023
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Provider Practice Location Address
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Address Line | 5200 DOUGLAS DR N
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City | CRYSTAL
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State | MN
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Zip | 55429-3104
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Country | US
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Telephone | 763-400-3628
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Fax | 763-342-4183
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Provider Business Mailing Address
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Address Line | 6694 MCKOWN CT
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City | INDEPENDENCE
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State | MN
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Zip | 55359-2200
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Country | US
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Telephone | 952-240-4944
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 970
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License Number State | MN
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