Healthcare Provider Details

I. General information

NPI: 1881092971
Provider Name (Legal Business Name): JAIMIE LYNN JOHNSTON LAC MAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2014
Last Update Date: 12/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7819 MEATH RD
BALTIMORE MD
21222
US

IV. Provider business mailing address

7819 MEATH RD
BALTIMORE MD
21222
US

V. Phone/Fax

Practice location:
  • Phone: 410-240-0270
  • Fax:
Mailing address:
  • Phone: 410-240-0270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR104146
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU01391
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: