Johnson, Mary Jo

Johnson, Mary Jo is an individual health care provider with primary practice located at 3625 W 65Th St Ste 100 , Edina MN 55435-2147. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife is her primary health care specialty. Johnson, Mary Jo can be contacted via phone (952) 920-7001.

Contact Information

Primary practice address
3625 W 65Th St Ste 100 Edina MN 55435-2147
Phone: (952) 920-7001
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife 367A00000X R123626-8 Minnesota
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X R123626-8 Minnesota

Profile Details

NPI number 1578550992
LBN Legal business name Johnson, Mary Jo
Credentials CNM, CNP
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 30th, 2005
Last updated Feb 12th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1578550992 NPPES
Minnesota MEDICAID 642215200

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