MEDICARE: DR. JAMIE ANN JOHANNES DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	51951	MN

General Provider Information

NPI Number	:	1407021637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMIE ANN JOHANNES DO

Provider Business Mailing Address
First Line	:	200 E PRINCE ST
Second Line	:
City	:	LAKE CRYSTAL
State	:	MN
Zip	:	56055-2043
Country	:	US
Telephone Number	:	507-726-6966
Fax Number	:	507-726-6939

Provider Business Practice Location Address
First Line	:	200 E PRINCE ST
Second Line	:
City	:	LAKE CRYSTAL
State	:	MN
Zip	:	56055-2043
Country	:	US
Telephone Number	:	952-200-5784
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2008
Last Update Date	:	09/17/2020

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