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General NPI Number Information
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NPI Number | 1225361793
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Entity Type | Individual
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Provider Name | LAURA EVA JOHNSON RN,CNP
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Gender | Female
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Dates
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Enumeration Date | 09/15/2009
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Last Update Date | 08/24/2011
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Provider Practice Location Address
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Address Line | 451 E SAINT GERMAIN ST SUITE 100
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City | SAINT CLOUD
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State | MN
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Zip | 56304-4649
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Country | US
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Telephone | 320-252-9526
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Fax | 320-252-4710
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Provider Business Mailing Address
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Address Line | 451 E SAINT GERMAIN ST SUITE 100
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City | SAINT CLOUD
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State | MN
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Zip | 56304-4649
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Country | US
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Telephone | 320-252-9526
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Fax | 320-252-4710
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | R153468-5
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License Number State | MN
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