Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife |
NPI | 1144784265 |
---|---|
Provider Name | Stephanie Dawn-Marie Johnson |
First Address | Dorchester, MA 02121-4116 |
Second Address | Dorchester, MA 02121-4116 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2019 |
Last Update Date | 23/01/2019 |