Healthcare Provider Details

I. General information

NPI: 1447932090
Provider Name (Legal Business Name): CHRISTA JANAE JOHNSON CMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2023
Last Update Date: 12/15/2023
Certification Date: 12/08/2023
Deactivation Date: 08/08/2023
Reactivation Date: 11/22/2023

III. Provider practice location address

47 N HURON ST
YPSILANTI MI
48197-2607
US

IV. Provider business mailing address

2127 GOLFSIDE RD
YPSILANTI MI
48197-8579
US

V. Phone/Fax

Practice location:
  • Phone: 734-484-3600
  • Fax:
Mailing address:
  • Phone: 734-460-4738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: