Individual provider Active NPI

Sao Slober Johnson

  • Registered Nurse
  • Brooklyn Park, MN
National Provider Identifier
1619828951
Registry record updated Feb 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
2485512 Issued in MN
Practice address
8967 Montegue Ter
Brooklyn Park, MN 55443-3706
Phone
(931) 266-5999
NPI assigned
Feb 4, 2026
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 4, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 2485512 MN Primary

Addresses

Primary practice location

8967 Montegue Ter
Brooklyn Park, MN 55443-3706

Mailing address

8967 Montegue Ter
Brooklyn Park, MN 55443-3706
Phone (931) 266-5999

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

LicenseStateTypeSpecialty
2485512MNMDRegistered Nurse

NPI Registry JSON

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

{
    "created_epoch": "1770163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770163200000",
    "number": "1619828951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8967 MONTEGUE TER",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554433706",
            "telephone_number": "931-266-5999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8967 MONTEGUE TER",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554433706",
            "telephone_number": "931-266-5999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "SAO",
        "middle_name": "SLOBER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-02-04",
        "last_updated": "2026-02-04",
        "certification_date": "2026-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MN",
            "license": "2485512",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn Park, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2026; 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.