| NPI | 1154754885 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ICEPHINE JOHNSON Nurse Practitioner 320-420-0268 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MN 682820800022) |
| Enumeration Date | 2013-08-16 |
| Last Update Date | 2013-08-16 |