Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0127X | Trauma Surgeon | 12469 | MN |
NPI | 1073042149 |
---|---|
Provider Name | Lauren A Johnson |
First Address | Robbinsdale, MN 55422-2926 |
Second Address | Robbinsdale, MN 55422-2926 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2017 |
Last Update Date | 13/09/2019 |