Provider Demographics
NPI:1700213840
Name:JOHNSON, JAMIE KAY
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:KAY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:KAY
Other - Last Name:FISCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19463 WALDEN AVE
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:MN
Mailing Address - Zip Code:55350-4230
Mailing Address - Country:US
Mailing Address - Phone:612-716-7364
Mailing Address - Fax:
Practice Address - Street 1:19463 WALDEN AVE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-4230
Practice Address - Country:US
Practice Address - Phone:612-716-7364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN164W00000X164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse