Basic Information
| Provider Information | |||||||||
| NPI: | 1427538875 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | KATE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4721 KILLARNEY DR | ||||||||
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| City: | GOLDEN VALLEY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554224806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512954867 | ||||||||
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| Practice Location | |||||||||
| Address1: | 303 E NICOLLET BLVD | ||||||||
| Address2: | |||||||||
| City: | BURNSVILLE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553374522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9524604000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2018 | ||||||||
| LastUpdateDate: | 08/15/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 367A00000X | 369 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.