Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | LM548 | CA |
NPI | 1114569316 |
---|---|
Provider Name | Jennifer Dee Johnson |
First Address | Big Sur, CA 93920-0109 |
Second Address | Carmel, CA 93923 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2019 |
Last Update Date | 09/10/2019 |