Provider Demographics
NPI:1528728086
Name:MUFF, JOHANN (CNA, OWNER)
Entity type:Individual
Prefix:MRS
First Name:JOHANN
Middle Name:
Last Name:MUFF
Suffix:
Gender:F
Credentials:CNA, OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 DOC HANSON ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK MILLS
Mailing Address - State:MN
Mailing Address - Zip Code:56567-4620
Mailing Address - Country:US
Mailing Address - Phone:218-639-2573
Mailing Address - Fax:
Practice Address - Street 1:402 DOC HANSON ST
Practice Address - Street 2:
Practice Address - City:NEW YORK MILLS
Practice Address - State:MN
Practice Address - Zip Code:56567-4620
Practice Address - Country:US
Practice Address - Phone:218-639-2573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-26
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10512543376K00000X
MN39818310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No376K00000XNursing Service Related ProvidersNurse's Aide