Provider Demographics
NPI:1184013013
Name:JOHNSON, SHAWN MARIE (ACNP-BC)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1753 KENDARBREN DR STE 612
Mailing Address - Street 2:
Mailing Address - City:JAMISON
Mailing Address - State:PA
Mailing Address - Zip Code:18929-1049
Mailing Address - Country:US
Mailing Address - Phone:855-200-8585
Mailing Address - Fax:215-741-1914
Practice Address - Street 1:1753 KENDARBREN DR STE 612
Practice Address - Street 2:
Practice Address - City:JAMISON
Practice Address - State:PA
Practice Address - Zip Code:18929-1049
Practice Address - Country:US
Practice Address - Phone:855-200-8585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-15
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0991453-NP363LA2100X
VA0024172257363LA2100X
DC1037500363LA2100X
PASP018787363LP0808X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health