Provider Demographics
NPI:1740018415
Name:JOHNSON, ALEXANDER GENE
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:GENE
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 7TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-4507
Mailing Address - Country:US
Mailing Address - Phone:701-864-0812
Mailing Address - Fax:
Practice Address - Street 1:3945 N 19TH ST APT 109
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-5489
Practice Address - Country:US
Practice Address - Phone:701-864-0812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND94157376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide