Individual
SHIRA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
IBCLC
Contact information
Practice address
4804 CASCADE RD SE, GRAND RAPIDS, MI 49546-3721
(517) 281-5814
Mailing address
2475 SINCLAIR AVE NE, GRAND RAPIDS, MI 49505-3602
(517) 281-5814
Taxonomy
Speciality
Code
Description
License number
State
174N00000X
Lactation Consultant (Non-RN)
Primary
L-108335
—
174N00000X
Lactation Consultant (Non-RN)
—
—
Other
Enumeration date
08/14/2017
Last updated
08/14/2017
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