Provider Demographics
NPI:1194276543
Name:JOHNSON, RACHEL KATHLEEN (PA)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:KATHLEEN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:KATHLEEN
Other - Last Name:HAUGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:14001 RIDGEDALE DR #100
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305
Mailing Address - Country:US
Mailing Address - Phone:952-473-0211
Mailing Address - Fax:952-473-7908
Practice Address - Street 1:916 SAINT PETER AVE #120
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:MN
Practice Address - Zip Code:55328
Practice Address - Country:US
Practice Address - Phone:763-230-2780
Practice Address - Fax:763-972-2230
Is Sole Proprietor?:No
Enumeration Date:2016-10-20
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12703363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant