Provider Demographics
NPI:1104984764
Name:JOHNSON, LINDA A (CNM)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:LINDY
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNM
Mailing Address - Street 1:2107 DWIGHT WAY STE 102
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2028
Mailing Address - Country:US
Mailing Address - Phone:510-644-0104
Mailing Address - Fax:510-649-0219
Practice Address - Street 1:2107 DWIGHT WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704
Practice Address - Country:US
Practice Address - Phone:510-644-0104
Practice Address - Fax:510-649-0219
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA516176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7550813Medicaid
7550813Medicare UPIN