Provider Demographics
NPI:1124570841
Name:NORMAN-JOHNSON, SHIRLEY
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:NORMAN-JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 EAST BADGER RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713
Mailing Address - Country:US
Mailing Address - Phone:608-250-2512
Mailing Address - Fax:
Practice Address - Street 1:115 EAST BADGER RD
Practice Address - Street 2:SUITE A
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713
Practice Address - Country:US
Practice Address - Phone:608-250-2512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI320981164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse