Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife |
NPI | 1033340666 |
---|---|
Provider Name | Jill R Johnson |
First Address | Erie, PA 16508-2634 |
Second Address | Erie, PA 16508-2634 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2009 |
Last Update Date | 09/03/2017 |