Provider Demographics
NPI:1396788717
Name:JOHNSON, KAREN E (CNP)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:E
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1047 DELANO WAY
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-4538
Mailing Address - Country:US
Mailing Address - Phone:651-491-2959
Mailing Address - Fax:651-342-1103
Practice Address - Street 1:1047 DELANO WAY
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-4538
Practice Address - Country:US
Practice Address - Phone:651-491-2959
Practice Address - Fax:651-342-1103
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1008674363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNS77608Medicare UPIN