Provider Demographics
NPI:1346907409
Name:JOHNSON, SERVEEN ANTOINETTE (DOULA)
Entity type:Individual
Prefix:
First Name:SERVEEN
Middle Name:ANTOINETTE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1713 AUTUMN DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-1727
Mailing Address - Country:US
Mailing Address - Phone:931-980-7601
Mailing Address - Fax:931-572-5252
Practice Address - Street 1:1713 AUTUMN DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-1727
Practice Address - Country:US
Practice Address - Phone:931-980-7601
Practice Address - Fax:931-572-5252
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA484-278-1648374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN85-3803834OtherSTATE OF TENNESSEE