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General NPI Number Information
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NPI Number | 1770110777
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Entity Type | Individual
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Provider Name | STEFFANI NICOLE JOHNSTON
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Gender | Female
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Dates
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Enumeration Date | 03/27/2020
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Last Update Date | 12/01/2023
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Provider Practice Location Address
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Address Line | 2405 8TH ST S STE 200
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City | MOORHEAD
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State | MN
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Zip | 56560-4200
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Country | US
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Telephone | 218-331-4866
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Fax | 218-331-4967
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Provider Business Mailing Address
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Address Line | 1900 SILVER LAKE RD NW STE 110
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City | NEW BRIGHTON
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State | MN
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Zip | 55112-1789
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Country | US
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Telephone | 651-628-9566
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Fax | 651-628-0411
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PAC0837
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License Number State | ND
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 14462
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License Number State | MN
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