Provider Demographics
NPI:1457073231
Name:BOND, JOHANNA MATILDA (CPM, RM)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:MATILDA
Last Name:BOND
Suffix:
Gender:F
Credentials:CPM, RM
Other - Prefix:
Other - First Name:JOHANNA
Other - Middle Name:MATILDA SUNG YOUNG
Other - Last Name:SHOULTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15896 E GUNNISON PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80017-4040
Mailing Address - Country:US
Mailing Address - Phone:603-340-8937
Mailing Address - Fax:
Practice Address - Street 1:15896 E GUNNISON PL
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80017-4040
Practice Address - Country:US
Practice Address - Phone:603-340-8937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMWR.0000217176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife