Provider Demographics
NPI:1063645224
Name:JOHNSON, SARAH MARY (FNP-BC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:MARY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6694 MCKOWN CT
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MN
Mailing Address - Zip Code:55359-2200
Mailing Address - Country:US
Mailing Address - Phone:952-240-4944
Mailing Address - Fax:
Practice Address - Street 1:5200 DOUGLAS DR N
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55429-3104
Practice Address - Country:US
Practice Address - Phone:763-400-3628
Practice Address - Fax:763-342-4183
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-03
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN970363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology