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General NPI Number Information
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NPI Number | 1902678428
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Entity Type | Individual
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Provider Name | NOWELL JOHNSON FNP-C
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Gender | Female
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Dates
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Enumeration Date | 10/27/2023
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Last Update Date | 03/21/2024
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Provider Practice Location Address
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Address Line | 1845 US HIGHWAY 59 SE STE 800
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City | THIEF RIVER FALLS
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State | MN
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Zip | 56701-4318
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Country | US
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Telephone | 218-681-7280
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Fax | 701-780-2489
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Provider Business Mailing Address
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Address Line | 1845 US HIGHWAY 59 SE STE 800
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City | THIEF RIVER FALLS
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State | MN
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Zip | 56701-4318
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Country | US
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Telephone | 218-469-3181
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 10930
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License Number State | MN
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