Provider Demographics
NPI:1801249743
Name:JOHNSON, KATHERINE EDNA (CNM)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:EDNA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:KATHERNINE
Other - Middle Name:EDNA
Other - Last Name:WALLETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-337-4487
Mailing Address - Fax:717-461-7149
Practice Address - Street 1:20 NORTH ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-2275
Practice Address - Country:US
Practice Address - Phone:717-637-7755
Practice Address - Fax:717-637-7142
Is Sole Proprietor?:No
Enumeration Date:2016-07-15
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW010410367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife