Provider Demographics
NPI:1407021637
Name:JOHANNES, JAMIE ANN (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:ANN
Last Name:JOHANNES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:JAMIE
Other - Middle Name:ANN
Other - Last Name:GERGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:200 E PRINCE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:56055-2043
Mailing Address - Country:US
Mailing Address - Phone:507-726-6966
Mailing Address - Fax:507-726-6939
Practice Address - Street 1:200 E PRINCE ST
Practice Address - Street 2:
Practice Address - City:LAKE CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:56055-2043
Practice Address - Country:US
Practice Address - Phone:952-200-5784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN51951207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine