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General NPI Number Information
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NPI Number | 1447672357
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Entity Type | Organization
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Legal Business Name | JOHANNA CONGLETON, CNM, PA
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Dates
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Enumeration Date | 01/11/2014
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Last Update Date | 07/27/2015
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Provider Practice Location Address
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Address Line | 9 MEDICAL PKWY PLAZA 4 STE 103
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City | DALLAS
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State | TX
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Zip | 75234-7858
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Country | US
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Telephone | 972-406-9911
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Fax | 972-406-9930
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Provider Business Mailing Address
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Address Line | 6750 N MACARTHUR BLVD 100
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City | IRVING
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State | TX
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Zip | 75039-2875
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Country | US
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Telephone | 972-406-9911
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Fax |
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Authorized Official
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Title or Position | PROVIDER/OWNER
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Name | MALATHI ELLIS
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Credential | MD
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Telephone | 972-406-9911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | CNM1795
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License Number State | TX
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