Johanna Brouse
Individual provider Active NPI Registered Nurse · Laporte, MN
NPI 1306387485 · NPPES record last updated Mar 9, 2017
Key facts
- NPI
- 1306387485
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- R-193263-0 (MN)
- Practice address
- 28803 450TH St
Laporte, MN 56461-4812 - Phone
- (218) 407-2376
- NPI assigned
- Mar 9, 2017
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R-193263-0 | MN | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | R-193263-0 | MN | Yes |
Addresses
Primary practice location
28803 450TH St
Laporte, MN 56461-4812
Mailing address
28803 450TH St
Laporte, MN 56461-4812
Phone (218) 407-2376
Other providers in Laporte, MN
All providers in Laporte, MN · Registered Nurse in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 9, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.