Healthcare Provider Details

I. General information

NPI: 1497747976
Provider Name (Legal Business Name): STEPHANIE LYNN JOHNSON C.N.M
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 06/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 STAGELINE ROAD
HUDSON WI
54016-7848
US

IV. Provider business mailing address

403 STAGELINE ROAD
HUDSON WI
54016-7848
US

V. Phone/Fax

Practice location:
  • Phone: 715-531-6800
  • Fax: 715-531-6801
Mailing address:
  • Phone: 715-531-6800
  • Fax: 715-531-6801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number148787
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: