Individual provider Active NPI

Russann Henriett Johnson, LPN

  • Licensed Practical Nurse
  • Fergus Falls, MN
National Provider Identifier
1902076532
Registry record updated Mar 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
L0498104 Issued in MN
Practice address
106 4TH Ave North
Fergus Falls, MN 56537-1034
Phone
(218) 998-3778
Fax
(218) 998-3187
NPI assigned
Mar 11, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X L0498104 MN Primary

Addresses

Primary practice location

106 4TH Ave North
Fergus Falls, MN 56537-1034

Mailing address

316 7TH St SE
Elbow Lake, MN 56531
Phone (218) 731-7393

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
L0498104MNMDLicensed Practical Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
CK Home Health Care Inc. Past Accepting new patients
CK Home Health Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1205193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205193600000",
    "number": "1902076532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "316 7TH ST SE",
            "city": "ELBOW LAKE",
            "state": "MN",
            "postal_code": "56531",
            "telephone_number": "218-731-7393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 4TH AVE NORTH",
            "city": "FERGUS FALLS",
            "state": "MN",
            "postal_code": "565371034",
            "telephone_number": "218-998-3778",
            "fax_number": "218-998-3187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "RUSSANN",
        "middle_name": "HENRIETT",
        "name_prefix": "Ms.",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-03-11",
        "last_updated": "2008-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "MN",
            "license": "L0498104",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fergus Falls, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2008; 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.