Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | D9559 | MN |
NPI | 1033247432 |
---|---|
Provider Name | Dr. Mary Elizabeth Johnson |
First Address | Edina, MN 55435-2131 |
Second Address | Edina, MN 55435-2131 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2007 |
Last Update Date | 08/07/2007 |