Provider Demographics
NPI:1467196857
Name:JOHNSTON, MOLLY ELIZABETH (IBCLC)
Entity Type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:ELIZABETH
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 489 BOX 1740
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09751-0018
Mailing Address - Country:US
Mailing Address - Phone:937-412-2304
Mailing Address - Fax:
Practice Address - Street 1:RUBEZAHLWEG 73
Practice Address - Street 2:
Practice Address - City:STUTTGART
Practice Address - State:BADEN-WURTENBURG
Practice Address - Zip Code:73056
Practice Address - Country:DE
Practice Address - Phone:937-412-2304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-22
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHL-306497174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN