Provider Demographics
NPI:1427026426
Name:JOHNSON, JENNIFER M (1 CNP, DNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:1 CNP, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MS21110Q
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:952-883-5375
Mailing Address - Fax:651-254-2801
Practice Address - Street 1:640 JACKSON ST - MC11108B
Practice Address - Street 2:HEALTHPARTNERS REGIONS SPECIALTY CLINICS
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2502
Practice Address - Country:US
Practice Address - Phone:651-254-4816
Practice Address - Fax:651-254-2801
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1450646363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN433078100Medicaid