=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114569316
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER DEE JOHNSON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2019
-----------------------------------------------------
Last Update Date | 10/09/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 38785 PALO COLORADO RD
-----------------------------------------------------
City | CARMEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-250-0634
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 109
-----------------------------------------------------
City | BIG SUR
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93920-0109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-747-4430
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 176B00000X
-----------------------------------------------------
Taxonomy Name | Midwife
-----------------------------------------------------
License Number | LM548
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------