NPI 1003362914

Tyler K Johnson, PAC

Practitioner Medical Physician Assistant Excelsior, MN

Practice location

Address: 675 Water St, Excelsior, MN 55331-3072
Phone: (952) 906-7855
Mailing address: 676 N Saint Clair St Suite 1600, Chicago, IL 60611-2927

Registered specialties

Medical Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363AM0700X Licence 085005949 (IL)

Other Physician Assistant providers in Minnesota →

Registry record

NPI: 1003362914
Entity type: Individual
Sex (as registered): Male
NPI issued: 31 Aug 2016
Record last updated: 7 May 2019

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.