Provider Demographics
NPI:1093169567
Name:JOHNSON, KIRSTEN LEE (RN, PHN, CDE)
Entity Type:Individual
Prefix:MS
First Name:KIRSTEN
Middle Name:LEE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN, PHN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112033 WARNER CIR
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-1437
Mailing Address - Country:US
Mailing Address - Phone:952-356-7549
Mailing Address - Fax:
Practice Address - Street 1:112033 WARNER CIR
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-1437
Practice Address - Country:US
Practice Address - Phone:952-356-7549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-157706-6163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator