Provider Demographics
NPI:1376797548
Name:JOHNSON, SHIRLEY J (CNA, RC)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:J
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CNA, RC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2613 W MARINE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-3420
Mailing Address - Country:US
Mailing Address - Phone:425-349-6700
Mailing Address - Fax:
Practice Address - Street 1:2613 W MARINE VIEW DR
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3420
Practice Address - Country:US
Practice Address - Phone:425-349-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC60056544101YM0800X
WANC10077468376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No376K00000XNursing Service Related ProvidersNurse's Aide