Provider Demographics
NPI:1740141415
Name:JOHNSON, ANNA MARIE (IBCLC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18420 PRESIDIO PL
Mailing Address - Street 2:
Mailing Address - City:ROUND HILL
Mailing Address - State:VA
Mailing Address - Zip Code:20141-3528
Mailing Address - Country:US
Mailing Address - Phone:240-285-9932
Mailing Address - Fax:
Practice Address - Street 1:821 S KING ST STE L
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-3922
Practice Address - Country:US
Practice Address - Phone:240-285-9932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-20
Last Update Date:2025-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN