Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 315 | NC |
NPI | 1023175585 |
---|---|
Provider Name | Ms. Marceal Schipper Johnson |
First Address | Fort Bragg, NC 28310-0001 |
Second Address | Fayetteville, NC 28303-3888 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 08/07/2007 |