MEDICARE: DEBORAH RUTH JOHNSON C.N.M.

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	309000231	IL
2	176B00000X	Midwife	515	CT

General Provider Information

NPI Number	:	1851440242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH RUTH JOHNSON C.N.M.

Provider Business Mailing Address
First Line	:	46 ALBION ST
Second Line	:
City	:	BRIDGEPORT
State	:	CT
Zip	:	06605-2602
Country	:	US
Telephone Number	:	203-330-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	509 PARK AVE
Second Line	:
City	:	BRIDGEPORT
State	:	CT
Zip	:	06604-5859
Country	:	US
Telephone Number	:	203-330-6000
Fax Number	:

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

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	03/18/2024

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