Provider Demographics
NPI:1902678428
Name:JOHNSON, NOWELL (FNP-C)
Entity Type:Individual
Prefix:
First Name:NOWELL
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 US HIGHWAY 59 SE STE 800
Mailing Address - Street 2:
Mailing Address - City:THIEF RIVER FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56701-4318
Mailing Address - Country:US
Mailing Address - Phone:218-469-3181
Mailing Address - Fax:
Practice Address - Street 1:1845 US HIGHWAY 59 SE STE 800
Practice Address - Street 2:
Practice Address - City:THIEF RIVER FALLS
Practice Address - State:MN
Practice Address - Zip Code:56701-4318
Practice Address - Country:US
Practice Address - Phone:218-681-7280
Practice Address - Fax:701-780-2489
Is Sole Proprietor?:No
Enumeration Date:2023-10-27
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10930363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily