Provider Demographics
NPI:1124105143
Name:JOHNSON, LEAH K (FNP)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:K
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 16TH ST SE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904
Mailing Address - Country:US
Mailing Address - Phone:507-288-8544
Mailing Address - Fax:507-288-8545
Practice Address - Street 1:300 3RD AVE SE
Practice Address - Street 2:SUITE 405
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-4619
Practice Address - Country:US
Practice Address - Phone:507-288-8544
Practice Address - Fax:507-288-8545
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNNP0946106363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN421521400Medicaid
MN500000368Medicare ID - Type Unspecified
S44981Medicare UPIN