Johnson, Debra Deanovic
Johnson, Debra Deanovic is an individual health care provider with primary practice located at 2220 Riverside Ave Mail Stop 31700A, Minneapolis MN 55454-1321. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Johnson, Debra Deanovic can be contacted via phone (612) 371-1600.Contact Information
Primary practice address
2220 Riverside Ave Mail Stop 31700A
Minneapolis MN 55454-1321
Phone: (612) 371-1600
Fax: (612) 371-1732
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 26260 | Minnesota |
Profile Details
| NPI number | 1124093265 |
|---|---|
| LBN Legal business name | Johnson, Debra Deanovic |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 22nd, 2006 |
| Last updated | Feb 28th, 2020 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1124093265 | NPPES |
| Minnesota | MEDICAID | 310382000 |
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