Provider Demographics
NPI:1831976927
Name:JOHNSEN, ABBY (NBCHWC)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:JOHNSEN
Suffix:
Gender:F
Credentials:NBCHWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4641 NELSON RD
Mailing Address - Street 2:
Mailing Address - City:BROOKSTON
Mailing Address - State:MN
Mailing Address - Zip Code:55711-8023
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4641 NELSON RD
Practice Address - Street 2:
Practice Address - City:BROOKSTON
Practice Address - State:MN
Practice Address - Zip Code:55711-8023
Practice Address - Country:US
Practice Address - Phone:218-391-3873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
A-3087597171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach