Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Nikolene Johnson

Individual provider Physician Assistant · NPI 1104363993

Nikolene Johnson is a Physician Assistant in Wausau, Wisconsin. Qualified in 2016, 10 years ago. Practices with ENT and Allergy Associates SC, a 25-clinician group and accepts Medicare assignment. Licensed in Minnesota.

Years since qualifying
10
Licensed in
MN
In the registry since
2017
Specialties on file
3
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Practice location Address checks out

512 S 28th Ave
Wausau, WI 54401-4147
Phone: (715) 847-2021
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 1104363993
Physician Assistant Taxonomy 363A00000X (MN)
Medical Physician Assistant Taxonomy 363AM0700X

Record details

NPI number1104363993
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedJanuary 31, 2017
Last updated in NPPESNovember 5, 2024
Certification dateNovember 5, 2024
Mailing address7920 Old Cedar Ave S, Bloomington, MN 55425-1207

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2016 (10 years in practice)
Group practice Ent And Allergy Associates Sc — 25 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Wausau