Provider Demographics
NPI:1922686278
Name:JOHNSON, LAUREN MAY (PA-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:MAY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12000 ELM CREEK BLVD N STE 350
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-7076
Mailing Address - Country:US
Mailing Address - Phone:763-494-7736
Mailing Address - Fax:763-494-7706
Practice Address - Street 1:12000 ELM CREEK BLVD N STE 350
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-7076
Practice Address - Country:US
Practice Address - Phone:763-494-7736
Practice Address - Fax:763-494-7706
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13506363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant