Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 10110 | WI |
Y | 363L00000X | Nurse Practitioner | 7967 | MN |
NPI | 1003459629 |
---|---|
Provider Name | Ms. Amber Erin Johnson |
First Address | Willmar, MN 56201-3556 |
Second Address | Willmar, MN 56201-3556 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2019 |
Last Update Date | 30/12/2020 |