Provider Demographics
NPI:1699043455
Name:JOHNSON, MEREDYTH ANN (CD (DONA))
Entity Type:Individual
Prefix:
First Name:MEREDYTH
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CD (DONA)
Other - Prefix:
Other - First Name:MEREDYTH
Other - Middle Name:ANN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CD(DONA)
Mailing Address - Street 1:4201 21ST AVE S APT 2
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-3046
Mailing Address - Country:US
Mailing Address - Phone:320-492-6112
Mailing Address - Fax:
Practice Address - Street 1:4201 21ST AVE S APT 2
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3046
Practice Address - Country:US
Practice Address - Phone:320-492-6112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula