Active NPI
Jean Johnson
- Registered Nurse
- Maple Grove, MN
National Provider Identifier
1366085268
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- R-135491-7
- Practice address
- 10467 93Rd Ave N
Maple Grove, MN 55369-4112 - Phone
- (651) 488-4655
- Fax
- (651) 488-4656
- NPI assigned
- Oct 23, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | R-135491-7 | MN | Primary |
Addresses
Primary practice location
10467 93Rd Ave N
Maple Grove, MN 55369-4112
Mailing address
10467 93Rd Ave N
Maple Grove, MN 55369-4112
Phone (651) 488-4655
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | jjohnson@regencyhhc.com |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R-135491-7 | MN | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1571788800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571788800000",
"number": "1366085268",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10467 93RD AVE N",
"city": "MAPLE GROVE",
"state": "MN",
"postal_code": "553694112",
"telephone_number": "651-488-4655",
"fax_number": "651-488-4656"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10467 93RD AVE N",
"city": "MAPLE GROVE",
"state": "MN",
"postal_code": "553694112",
"telephone_number": "651-488-4655",
"fax_number": "651-488-4656"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "JEAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-10-23",
"last_updated": "2019-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "MN",
"license": "R-135491-7",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "jjohnson@regencyhhc.com",
"affiliation": "N",
"address_1": "10467 93rd Ave N",
"city": "Maple Grove",
"state": "MN",
"country_code": "US",
"postal_code": "553694112",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Maple Grove, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.