Provider Demographics
NPI:1659347052
Name:JOHNSON, JENNIFER SUSAN (CRNA)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:SUSAN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:SUSAN
Other - Last Name:HOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:2828 CHICAGO AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407
Mailing Address - Country:US
Mailing Address - Phone:612-871-7639
Mailing Address - Fax:612-872-0302
Practice Address - Street 1:800 E 28TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404
Practice Address - Country:US
Practice Address - Phone:612-871-7639
Practice Address - Fax:612-872-0302
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1461143367500000X
MNCRNA073617367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN421690300Medicaid
MN451M9HOOtherBCBSMN
430005771Medicare UPIN
MN421690300Medicaid