Healthcare Provider Details

I. General information

NPI: 1407774953
Provider Name (Legal Business Name): AMY M JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2771 BIG EMPTY PL
BERTHOUD CO
80513-6000
US

IV. Provider business mailing address

2771 BIG EMPTY PL
BERTHOUD CO
80513-6000
US

V. Phone/Fax

Practice location:
  • Phone: 970-219-5197
  • Fax:
Mailing address:
  • Phone: 970-219-5197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: