Provider Demographics
NPI:1043554652
Name:JOHNSON, ANGELA SUSAN (NP-C)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:SUSAN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6363 FRANCE AVE S
Mailing Address - Street 2:SUITE 400
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2129
Mailing Address - Country:US
Mailing Address - Phone:952-920-2070
Mailing Address - Fax:952-920-7444
Practice Address - Street 1:6363 FRANCE AVE S
Practice Address - Street 2:SUITE 400
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2129
Practice Address - Country:US
Practice Address - Phone:952-920-2070
Practice Address - Fax:952-920-7444
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR187836-7363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health