Provider Demographics
NPI:1629191598
Name:JOHNSON-GRASS, AMY ELIZABETH (ND, LM, LN, CPM)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:ELIZABETH
Last Name:JOHNSON-GRASS
Suffix:
Gender:F
Credentials:ND, LM, LN, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:968 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-3014
Mailing Address - Country:US
Mailing Address - Phone:651-895-2520
Mailing Address - Fax:
Practice Address - Street 1:968 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-3014
Practice Address - Country:US
Practice Address - Phone:651-895-2520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNN192133N00000X
175F00000X
MN1018176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No175F00000XOther Service ProvidersNaturopath