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NPI Code Detail

MEDICARE: JOHANNA CLARA AYERS CNP

MEDICARE: JOHANNA CLARA AYERS CNP
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
1363LF0000XFamily Nurse Practitioner7021MN

General Provider Information

NPI Number : 1629611033
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHANNA CLARA AYERS CNP
Provider Business Mailing Address
First Line : 2925 DAKOTA AVE S
Second Line :
City : ST LOUIS PARK
State : MN
Zip : 55416-1834
Country : US
Telephone Number : 952-999-1233
Fax Number :
Provider Business Practice Location Address
First Line : 4656 EXCELSIOR BLVD
Second Line :
City : ST LOUIS PARK
State : MN
Zip : 55416-4938
Country : US
Telephone Number : 952-929-0140
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2019
Last Update Date : 10/18/2019

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