Provider Demographics
NPI:1952057077
Name:JOHNSON, LAUREN DIANA (DOULA)
Entity Type:Individual
Prefix:PROF
First Name:LAUREN
Middle Name:DIANA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3149 PIONEER TRAILS LOOP
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-3506
Mailing Address - Country:US
Mailing Address - Phone:863-698-1170
Mailing Address - Fax:
Practice Address - Street 1:3149 PIONEER TRAILS LOOP
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-3506
Practice Address - Country:US
Practice Address - Phone:863-698-1170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174N00000X
FL374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN