Provider Demographics
NPI:1639374960
Name:JOHNSON, MANDI LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:MANDI
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6002
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58206-6002
Mailing Address - Country:US
Mailing Address - Phone:701-780-5000
Mailing Address - Fax:701-777-6860
Practice Address - Street 1:1375 S COLUMBIA RD STE E
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4015
Practice Address - Country:US
Practice Address - Phone:701-317-7071
Practice Address - Fax:701-335-7547
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2025-05-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NDPT11698207Q00000X
NDTRL10631207Q00000X
ND11698207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine