Provider Demographics
NPI:1710458922
Name:JOHNSON, EMILY MADISON
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:MADISON
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 PEPPERWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-3578
Mailing Address - Country:US
Mailing Address - Phone:650-644-5131
Mailing Address - Fax:
Practice Address - Street 1:2 PEPPERWOOD CT
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-3578
Practice Address - Country:US
Practice Address - Phone:650-644-5131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula