Provider Demographics
NPI:1255300786
Name:JOHNSON, ANNE I (CNM)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:I
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1866 SKILLMAN AVE W
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-5426
Mailing Address - Country:US
Mailing Address - Phone:651-639-9375
Mailing Address - Fax:
Practice Address - Street 1:1983 SLOAN PL
Practice Address - Street 2:SUITE 1
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55117-2087
Practice Address - Country:US
Practice Address - Phone:651-326-5700
Practice Address - Fax:651-326-5715
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR065397-8176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNS78985Medicare UPIN