Provider Demographics
NPI:1043794944
Name:JOHNS, KATHERINE L
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:L
Last Name:JOHNS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 GIDDINGS AVE STE L5
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1471
Mailing Address - Country:US
Mailing Address - Phone:443-333-0860
Mailing Address - Fax:
Practice Address - Street 1:703 GIDDINGS AVE STE L5
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1471
Practice Address - Country:US
Practice Address - Phone:443-333-0860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-18
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02508171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD83-1532430OtherIRS