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General NPI Number Information
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NPI Number | 1780987818
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Entity Type | Individual
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Provider Name | JENNA JOHNSON NP
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Gender | Female
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Dates
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Enumeration Date | 12/11/2010
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Last Update Date | 05/03/2021
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Provider Practice Location Address
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Address Line | 9900 BREN RD EAST MAIL ROUTE MN 008-B213
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City | MINNETONKA
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State | MN
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Zip | 55343
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Country | US
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Telephone | 480-490-3507
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1459
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City | MINNEAPOLIS
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State | MN
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Zip | 55440-1459
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95011251
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP60908265
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 813759
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License Number State | NV
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP11439
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License Number State | AZ
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