MEDICARE: MS. LINDA R. JOHNSON CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367A00000X	Advanced Practice Midwife	4704214498	MI
2	367A00000X	Advanced Practice Midwife	NM04013	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720071939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LINDA R. JOHNSON CNM

Provider Business Mailing Address
First Line	:	1715 W DEAN RD
Second Line	:	SUITE C
City	:	TEMPERANCE
State	:	MI
Zip	:	48182-9406
Country	:	US
Telephone Number	:	734-847-8100
Fax Number	:	734-847-6824

Provider Business Practice Location Address
First Line	:	1715 W DEAN RD
Second Line	:	SUITE C
City	:	TEMPERANCE
State	:	MI
Zip	:	48182-9406
Country	:	US
Telephone Number	:	734-847-8100
Fax Number	:	734-847-6824

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	03/19/2012

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