1982675369 NPI number — DR. ERIKA L JOHNSON MD

Table of content: DR. ERIKA L JOHNSON MD (NPI 1982675369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982675369 NPI number — DR. ERIKA L JOHNSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
ERIKA
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982675369
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
610 30TH AVE W
Provider Second Line Business Mailing Address:
ALEXANDRIA CLINIC
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-763-5123
Provider Business Mailing Address Fax Number:
320-763-7883

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
610 30TH AVE W
Provider Second Line Business Practice Location Address:
ALEXANDRIA CLINIC
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-763-5123
Provider Business Practice Location Address Fax Number:
320-763-7883
Provider Enumeration Date:
02/01/2006

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: 207V00000X , with the licence number:  29760 , 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: 429885300 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00005151 . This is a "RR MEDICARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com