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NPI Code Detail

MEDICARE: DR. MANDI LYNN JOHNSON MD

MEDICARE: DR. MANDI LYNN JOHNSON MD
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
1207Q00000XFamily Medicine PhysicianPT11698ND
2207Q00000XFamily Medicine Physician11698ND
3207Q00000XFamily Medicine PhysicianTRL10631ND

General Provider Information

NPI Number : 1639374960
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MANDI LYNN JOHNSON MD
Provider Business Mailing Address
First Line : PO BOX 6002
Second Line :
City : GRAND FORKS
State : ND
Zip : 58206-6002
Country : US
Telephone Number : 701-780-5000
Fax Number : 701-777-6860
Provider Business Practice Location Address
First Line : 1375 S COLUMBIA RD STE E
Second Line :
City : GRAND FORKS
State : ND
Zip : 58201-4015
Country : US
Telephone Number : 701-317-7071
Fax Number : 701-335-7547
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2007
Last Update Date : 02/16/2026

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