Provider Demographics
NPI:1609078351
Name:JOHNSON, ANNE MIKKELSON (RN)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MIKKELSON
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5179 MILLY LN SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55902-3532
Mailing Address - Country:US
Mailing Address - Phone:507-280-6876
Mailing Address - Fax:
Practice Address - Street 1:5179 MILLY LN SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-3532
Practice Address - Country:US
Practice Address - Phone:507-280-6876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR097833-6163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health