Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | 2357 | MN |
Y | 363LA2200X | Nurse Practitioner - Adult Health | 2357 | MN |
N | 363LG0600X | Nurse Practitioner - Gerontology | 2357 | MN |
NPI | 1023253945 |
---|---|
Provider Name | Susan Marie Johnson-Sickel |
First Address | Bloomington, MN 55425-4516 |
Second Address | Saint Paul, MN 55101-2502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2008 |
Last Update Date | 13/03/2019 |