Provider Demographics
NPI:1457024168
Name:JOHNSON, BRIDGET MARIE (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:MARIE
Other - Last Name:VETSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1900 CENTRACARE CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-5000
Mailing Address - Country:US
Mailing Address - Phone:320-240-2100
Mailing Address - Fax:
Practice Address - Street 1:12800 ROLLING RIDGE RD
Practice Address - Street 2:
Practice Address - City:BECKER
Practice Address - State:MN
Practice Address - Zip Code:55308-8838
Practice Address - Country:US
Practice Address - Phone:763-261-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8204363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily