Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant |
NPI | 1053819912 |
---|---|
Provider Name | Ashley P B Johnson |
First Address | Petersburg, VA 23805-1649 |
Second Address | Petersburg, VA 23805-1649 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2018 |
Last Update Date | 25/01/2018 |