Provider Demographics
NPI:1821869462
Name:JOHNSON, JAZMIN MONIQUE
Entity Type:Individual
Prefix:
First Name:JAZMIN
Middle Name:MONIQUE
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 1:401 E SUMMIT AVE UNIT 78
Mailing Address - Street 2:
Mailing Address - City:TELFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18969-1233
Mailing Address - Country:US
Mailing Address - Phone:267-916-2971
Mailing Address - Fax:
Practice Address - Street 1:401 E SUMMIT ST UNIT 78
Practice Address - Street 2:
Practice Address - City:TELFORD
Practice Address - State:PA
Practice Address - Zip Code:18969-1233
Practice Address - Country:US
Practice Address - Phone:267-916-2971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-11
Last Update Date:2024-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay