Provider Demographics
NPI:1225154529
Name:SCRANTON-JOHNSTON, SHARON MICHELLE (NP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:MICHELLE
Last Name:SCRANTON-JOHNSTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 SAN MATEO BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-1434
Mailing Address - Country:US
Mailing Address - Phone:505-265-9511
Mailing Address - Fax:505-268-4350
Practice Address - Street 1:825 S SHIELDS ST STE 6&7
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521-3590
Practice Address - Country:US
Practice Address - Phone:970-493-0281
Practice Address - Fax:970-493-0729
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR42099363L00000X
COAPN.0996697-NP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM20355092Medicaid
CO9000197999Medicaid