Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 7640 | MN |
NPI | 1053554113 |
---|---|
Provider Name | Kristina R Johnson |
First Address | Minneapolis, MN 55406-2704 |
Second Address | Minneapolis, MN 55406-2704 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2009 |
Last Update Date | 19/04/2009 |