Basic Information
| Provider Information | |||||||||
| NPI: | 1497747976 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | C.N.M | ||||||||
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| Mailing Information | |||||||||
| Address1: | 403 STAGELINE ROAD | ||||||||
| Address2: | |||||||||
| City: | HUDSON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 540167848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7155316800 | ||||||||
| FaxNumber: | 7155316801 | ||||||||
| Practice Location | |||||||||
| Address1: | 403 STAGELINE ROAD | ||||||||
| Address2: | |||||||||
| City: | HUDSON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 540167848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7155316800 | ||||||||
| FaxNumber: | 7155316801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2005 | ||||||||
| LastUpdateDate: | 06/24/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 148787 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.