Provider Demographics
NPI:1134588510
Name:JOHNSON, RACHEL MARIE (RN, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:MARIE
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 1:19 SCHROEDER DR
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-7865
Mailing Address - Country:US
Mailing Address - Phone:405-314-4132
Mailing Address - Fax:
Practice Address - Street 1:19 SCHROEDER DR
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-7865
Practice Address - Country:US
Practice Address - Phone:405-314-4132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-15
Last Update Date:2016-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95062256163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant