Provider Demographics
NPI:1669715603
Name:JOHNSON, JANINE (RN, CNP)
Entity type:Individual
Prefix:MS
First Name:JANINE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14621 RYAN ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345-6447
Mailing Address - Country:US
Mailing Address - Phone:320-630-9091
Mailing Address - Fax:
Practice Address - Street 1:811 2ND ST SE
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345-3559
Practice Address - Country:US
Practice Address - Phone:320-631-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR164584-6363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily