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General NPI Number Information
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NPI Number | 1851060636
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Entity Type | Individual
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Provider Name | AMANDA NYCOL JOHNSON CPNP
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Gender | Female
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Dates
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Enumeration Date | 09/07/2021
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 5703 LACHMAN AVE NE
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City | ALBERTVILLE
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State | MN
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Zip | 55301-3973
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Country | US
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Telephone | 763-284-1877
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Fax | 763-205-5834
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Provider Business Mailing Address
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Address Line | 1772 STIEGER LAKE LN STE 220
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City | VICTORIA
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State | MN
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Zip | 55386-7720
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Country | US
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Telephone | 952-443-4600
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Fax | 952-443-4604
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 8495
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 8495
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License Number State | MN
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