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General NPI Number Information
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NPI Number | 1154789741
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Entity Type | Individual
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Provider Name | ENRICO RAMON JOHNSON NP-C
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Gender | Male
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Dates
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Enumeration Date | 02/10/2016
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Last Update Date | 02/08/2019
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Provider Practice Location Address
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Address Line | 1925 WOODWINDS DR
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City | WOODBURY
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State | MN
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Zip | 55125-4445
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Country | US
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Telephone | 651-232-0100
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Fax |
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Provider Business Mailing Address
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Address Line | 1415 LILAC DR N STE 190
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City | GOLDEN VALLEY
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State | MN
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Zip | 55422-4544
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Country | US
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Telephone | 763-267-8701
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Fax | 763-231-9602
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | CNP 4417
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License Number State | MN
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