Provider Demographics
NPI:1649055195
Name:JOHANNING, LINDSEY (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:JOHANNING
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12572 COUNTY 106
Mailing Address - Street 2:
Mailing Address - City:PARK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56470-4726
Mailing Address - Country:US
Mailing Address - Phone:218-616-2773
Mailing Address - Fax:
Practice Address - Street 1:12572 COUNTY 106
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-4726
Practice Address - Country:US
Practice Address - Phone:218-616-2773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2023058778363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health