Provider Demographics
NPI:1437649886
Name:JOHNSON, SHARNETTE (RN)
Entity Type:Individual
Prefix:
First Name:SHARNETTE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SHARNETTE
Other - Middle Name:N
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:1636 3RD AVE # 178
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3622
Mailing Address - Country:US
Mailing Address - Phone:347-605-0980
Mailing Address - Fax:
Practice Address - Street 1:1636 3RD AVE # 178
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-3622
Practice Address - Country:US
Practice Address - Phone:347-605-0980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-11
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY623529163WI0500X, 163WL0100X, 172V00000X, 174H00000X, 374J00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No374J00000XNursing Service Related ProvidersDoula