1861483711 NPI number — WENDI A JOHNSON MD

Table of content: WENDI A JOHNSON MD (NPI 1861483711)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861483711 NPI number — WENDI A JOHNSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
WENDI
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JOHNSON-HAAS
Provider Other First Name:
WENDI
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1861483711
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CROSBY
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56441-1645
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-546-7000
Provider Business Mailing Address Fax Number:
218-546-4400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CROSBY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56441-1645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-546-7000
Provider Business Practice Location Address Fax Number:
218-546-4400
Provider Enumeration Date:
10/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  42414 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 127726 . This is a "U CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: COMP . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 370015800 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 519112200 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: COMP . This is a "MMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1200672 . This is a "MEDICA HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2115882 . This is a "FIRST HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 940644 . This is a "ARAZ GROUP AMERICAS PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1023002 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 86D69HO . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: COMP . This is a "ONE HEALTH PLAN GREAT WES" identifier . This identifiers is of the category "OTHER".
  • Identifier: HP30134 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".




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