Provider Demographics
NPI:1295012508
Name:JOHNSON, SHANNON CHRISTINA (PA-C)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:CHRISTINA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:CHRISTINA
Other - Last Name:MALAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:13111 E. BRIARWOOD AVE #105
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112
Mailing Address - Country:US
Mailing Address - Phone:303-632-3640
Mailing Address - Fax:303-632-3642
Practice Address - Street 1:13111 E. BRIARWOOD AVE #15
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112
Practice Address - Country:US
Practice Address - Phone:303-632-3640
Practice Address - Fax:303-632-3642
Is Sole Proprietor?:No
Enumeration Date:2011-11-15
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5036363AM0700X
CO4032363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical