Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | LMW-0043 | SC |
NPI | 1083944946 |
---|---|
Provider Name | Lisa Marie Johnson |
First Address | Fort Mill, SC 29708 |
Second Address | Fort Mill, SC 29708 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2009 |
Last Update Date | 28/12/2009 |