Provider Demographics
NPI:1205131943
Name:JOHNSON, STEVEN ALAN (RN)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:ALAN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 924
Mailing Address - Street 2:
Mailing Address - City:NEW ULM
Mailing Address - State:MN
Mailing Address - Zip Code:56073-1728
Mailing Address - Country:US
Mailing Address - Phone:507-359-2756
Mailing Address - Fax:507-354-1260
Practice Address - Street 1:6 NORTH MINNESOTA STREET
Practice Address - Street 2:
Practice Address - City:NEW ULM
Practice Address - State:MN
Practice Address - Zip Code:56073-1728
Practice Address - Country:US
Practice Address - Phone:507-359-2756
Practice Address - Fax:507-354-1260
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 197563-9163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse