Colette Rae Johnson, RN

Primary specialty

Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0808X

License

2185949 Issued in MN

Practice address

5500 94TH Ave N Ofc Building
Brooklyn Park, MN 55443-1992

Phone

(763) 843-1223

NPI assigned

Jan 12, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Colette Rae Anderson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1705017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705017600000",
    "number": "1104697564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5960 142ND AVE NW",
            "city": "RAMSEY",
            "state": "MN",
            "postal_code": "553035644",
            "telephone_number": "763-843-1223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5500 94TH AVE N OFC BUILDING",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554431992",
            "telephone_number": "763-843-1223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "COLETTE",
        "middle_name": "RAE",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-12",
        "last_updated": "2024-01-12",
        "certification_date": "2024-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "MN",
            "license": "2185949",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "COLETTE",
            "last_name": "ANDERSON",
            "middle_name": "RAE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Jo G Theisen DC, PA
• Katie Lyn Jensen Johnson, MA, LMFT
• Marissa Johnson
• Michael Wayne Johnson, DDS
• Sao Slober Johnson
• Terrell Gayperail Johnson, LICSW

• Psychiatric/Mental Health Registered Nurse in Brooklyn Park, MN
• Providers in Brooklyn Park, MN by specialty
• Psychiatric/Mental Health Registered Nurse in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.