Provider Demographics
NPI:1679330328
Name:JOHNSON, MINDI LYNNE (DNP, RN, AGCNS-BC)
Entity Type:Individual
Prefix:DR
First Name:MINDI
Middle Name:LYNNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DNP, RN, AGCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48146-3126
Mailing Address - Country:US
Mailing Address - Phone:734-365-2821
Mailing Address - Fax:
Practice Address - Street 1:436 STEWART AVE
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-3126
Practice Address - Country:US
Practice Address - Phone:734-365-2821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704246822163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics