Provider Demographics
NPI:1093185415
Name:MAUSS, JOHANNA MIRIAM SIMMERMAN (ND)
Entity Type:Individual
Prefix:DR
First Name:JOHANNA
Middle Name:MIRIAM SIMMERMAN
Last Name:MAUSS
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 ISLINGTON STREET, SUITE 2B
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801
Mailing Address - Country:US
Mailing Address - Phone:603-610-8882
Mailing Address - Fax:603-643-0943
Practice Address - Street 1:501 ISLINGTON STREET, SUITE 2B
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801
Practice Address - Country:US
Practice Address - Phone:603-610-8882
Practice Address - Fax:603-463-0943
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-28
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15-1503175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath