Provider Demographics
NPI:1619514973
Name:JOHNSON, JULIE ANN (RN IBCLC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W ALDER ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4123
Mailing Address - Country:US
Mailing Address - Phone:406-241-9720
Mailing Address - Fax:
Practice Address - Street 1:301 W ALDER ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4123
Practice Address - Country:US
Practice Address - Phone:406-241-9720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN-28541163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant