Provider Demographics
NPI:1902313869
Name:JOHNSON, DANIKA LEE (IBCLC, RLC)
Entity Type:Individual
Prefix:
First Name:DANIKA
Middle Name:LEE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:IBCLC, RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21509 RUNIONS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BROADWAY
Mailing Address - State:VA
Mailing Address - Zip Code:22815-2002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:308 COMERTOWN RD
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:VA
Practice Address - Zip Code:22849-4009
Practice Address - Country:US
Practice Address - Phone:540-705-7568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-01
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAL-131279174N00000X
VA0129-000155176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty