Provider Demographics
NPI:1578626057
Name:JOHNSTON, SHERISSE YVONNE (CNM)
Entity Type:Individual
Prefix:MRS
First Name:SHERISSE
Middle Name:YVONNE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MISS
Other - First Name:SHERISSE
Other - Middle Name:YVONNE
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:3059 BIERCE CIR
Mailing Address - Street 2:
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-3204
Mailing Address - Country:US
Mailing Address - Phone:330-405-8929
Mailing Address - Fax:
Practice Address - Street 1:13944 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:EAST CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-3832
Practice Address - Country:US
Practice Address - Phone:216-767-4242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN235338163W00000X
OHNM03561367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0373608Medicaid
OH0373608Medicaid
OHJONM03001Medicare ID - Type Unspecified