Provider Demographics
NPI:1447932090
Name:JOHNSON, CHRISTA JANAE (CMA)
Entity type:Individual
Prefix:
First Name:CHRISTA
Middle Name:JANAE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2127 GOLFSIDE RD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-8579
Mailing Address - Country:US
Mailing Address - Phone:734-460-4738
Mailing Address - Fax:
Practice Address - Street 1:47 N HURON ST
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-2607
Practice Address - Country:US
Practice Address - Phone:734-484-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-03
Last Update Date:2023-12-15
Deactivation Date:2023-08-08
Deactivation Code:
Reactivation Date:2023-11-22
Provider Licenses
StateLicense IDTaxonomies
MI374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula