Provider Demographics
NPI:1548650815
Name:JOHNSON, DORIS YVETT (CNM, NP)
Entity type:Individual
Prefix:MRS
First Name:DORIS
Middle Name:YVETT
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CNM, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 SALEM CHURCH RD APT 108
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-6009
Mailing Address - Country:US
Mailing Address - Phone:218-590-5115
Mailing Address - Fax:
Practice Address - Street 1:1301 SAM PERRY BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-8420
Practice Address - Country:US
Practice Address - Phone:540-741-1276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001147341163WW0101X
VA0024147341207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory