Provider Demographics
NPI:1144784265
Name:JOHNSON, STEPHANIE DAWN-MARIE (CPM)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:DAWN-MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MAYBROOK ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02121-4116
Mailing Address - Country:US
Mailing Address - Phone:617-833-9396
Mailing Address - Fax:
Practice Address - Street 1:3 MAYBROOK ST
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02121-4116
Practice Address - Country:US
Practice Address - Phone:617-833-9396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife