Provider Demographics
NPI:1821586678
Name:JOHNSON, JUNE (RN)
Entity Type:Individual
Prefix:MS
First Name:JUNE
Middle Name:
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 1:221 3RD AVE SW
Mailing Address - Street 2:
Mailing Address - City:CLEARBROOK
Mailing Address - State:MN
Mailing Address - Zip Code:56634-4241
Mailing Address - Country:US
Mailing Address - Phone:218-776-3508
Mailing Address - Fax:218-776-3507
Practice Address - Street 1:221 3RD AVE SW
Practice Address - Street 2:
Practice Address - City:CLEARBROOK
Practice Address - State:MN
Practice Address - Zip Code:56634-4241
Practice Address - Country:US
Practice Address - Phone:218-776-3508
Practice Address - Fax:218-776-3507
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN253Z00000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1380965OtherREGISTERED NURSE