Provider Demographics
NPI:1477129989
Name:JOHNSON, SHALAYNA LYNISE
Entity Type:Individual
Prefix:
First Name:SHALAYNA
Middle Name:LYNISE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1665 BROWNSTONE BLVD APT 3
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1308
Mailing Address - Country:US
Mailing Address - Phone:419-466-5094
Mailing Address - Fax:
Practice Address - Street 1:1665 BROWNSTONE BLVD APT 3
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-1308
Practice Address - Country:US
Practice Address - Phone:419-466-5094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400420281004376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide