Provider Demographics
NPI:1558073361
Name:JOHANSEN, ANNA ELIZABETH (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:ELIZABETH
Last Name:JOHANSEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1597 290TH AVE
Mailing Address - Street 2:
Mailing Address - City:GARVIN
Mailing Address - State:MN
Mailing Address - Zip Code:56132-1240
Mailing Address - Country:US
Mailing Address - Phone:507-829-9295
Mailing Address - Fax:
Practice Address - Street 1:100 HEALTHY WAY
Practice Address - Street 2:
Practice Address - City:OLIVIA
Practice Address - State:MN
Practice Address - Zip Code:56277-1117
Practice Address - Country:US
Practice Address - Phone:900-916-1836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-23
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9836363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care