Provider Demographics
NPI:1598916017
Name:JOHNSON, CHERYL (ND)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:DR
Other - First Name:CHERYL
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ND
Mailing Address - Street 1:PO BOX 148
Mailing Address - Street 2:
Mailing Address - City:MENDOCINO
Mailing Address - State:CA
Mailing Address - Zip Code:95460-0148
Mailing Address - Country:US
Mailing Address - Phone:707-397-1618
Mailing Address - Fax:
Practice Address - Street 1:LITTLE LAKE RD.
Practice Address - Street 2:
Practice Address - City:MENDOCINO
Practice Address - State:CA
Practice Address - Zip Code:95460-0970
Practice Address - Country:US
Practice Address - Phone:760-466-7581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-02
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND-112175F00000X
AZ05-864175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath