Provider Demographics
NPI:1417288945
Name:JOHNSON, AMANDA KAY (CSA)
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:KAY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:114 W. MAIN ST.
Mailing Address - Street 2:PO BOX 54
Mailing Address - City:DODGE CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55927
Mailing Address - Country:US
Mailing Address - Phone:507-374-2335
Mailing Address - Fax:
Practice Address - Street 1:201 W CENTER ST EI-01 SURGICAL ASSISTANT
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-3003
Practice Address - Country:US
Practice Address - Phone:507-266-2827
Practice Address - Fax:507-266-1978
Is Sole Proprietor?:No
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical