Provider Demographics
NPI:1801936307
Name:JOHNSON, KAREN DOLORES (RN)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:DOLORES
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5280 GREENWOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55804-2934
Mailing Address - Country:US
Mailing Address - Phone:218-525-0283
Mailing Address - Fax:
Practice Address - Street 1:5280 GREENWOOD ROAD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55804-2934
Practice Address - Country:US
Practice Address - Phone:218-525-0283
Practice Address - Fax:218-525-0283
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38331400Medicaid