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General NPI Number Information
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NPI Number | 1205971611
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Entity Type | Individual
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Provider Name | MATTHEW JOHN JOHNSON
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Gender | Male
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2200 UNIVERSITY AVE W STE 160
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City | SAINT PAUL
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State | MN
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Zip | 55114-1841
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Country | US
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Telephone | 651-917-3634
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Fax | 651-917-3620
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Provider Business Mailing Address
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Address Line | 20599 HAMPSHIRE WAY
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City | LAKEVILLE
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State | MN
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Zip | 55044-4671
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Country | US
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Telephone |
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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 | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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