Provider Demographics
NPI:1548650278
Name:FURZLAND, JOHNATHAN R (NP-C)
Entity type:Individual
Prefix:
First Name:JOHNATHAN
Middle Name:R
Last Name:FURZLAND
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7936 UNIVERSITY AVE NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-1860
Mailing Address - Country:US
Mailing Address - Phone:952-417-6865
Mailing Address - Fax:612-428-4216
Practice Address - Street 1:7936 UNIVERSITY AVE NE
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-1860
Practice Address - Country:US
Practice Address - Phone:952-417-6865
Practice Address - Fax:612-428-4216
Is Sole Proprietor?:No
Enumeration Date:2015-02-03
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1920040363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH400257826Medicare PIN