Provider Demographics
NPI:1447861554
Name:JOHNSON, EMILY MARGARET (CNM, IBCLC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:MARGARET
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CNM, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 CASEY LN
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-7744
Mailing Address - Country:US
Mailing Address - Phone:818-266-6068
Mailing Address - Fax:
Practice Address - Street 1:7301 GARLAND AVE
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6417
Practice Address - Country:US
Practice Address - Phone:818-266-6068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-12
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN215447163WL0100X
DCRN1060358367A00000X
MDAC003199367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCRN1060358OtherDC CNM LICENSE
MDAC003199OtherMARYLAND CNM LICENSE