Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 15-1503 | AZ |
NPI | 1093185415 |
---|---|
Provider Name | Dr. Johanna Miriam Simmerman Mauss |
First Address | Portsmouth, NH 03801 |
Second Address | Portsmouth, NH 03801 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2015 |
Last Update Date | 25/10/2017 |