Healthcare Provider Details

I. General information

NPI: 1134223217
Provider Name (Legal Business Name): MARIA CHRISTINA JOHNSON CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 HIGHLAND AVE SE STE 303
ROANOKE VA
24013-2253
US

IV. Provider business mailing address

213 S JEFFERSON ST STE 1006
ROANOKE VA
24011-1713
US

V. Phone/Fax

Practice location:
  • Phone: 540-985-9715
  • Fax: 540-985-8487
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number0024186566
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberR132976
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number0024186566
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: