Provider Demographics
NPI:1982473484
Name:JOHANSON, RACHEL LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:LYNN
Last Name:JOHANSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3112 DUBLIN DR
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-6424
Mailing Address - Country:US
Mailing Address - Phone:701-527-4334
Mailing Address - Fax:
Practice Address - Street 1:3112 DUBLIN DR
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-6424
Practice Address - Country:US
Practice Address - Phone:701-527-4334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant