Provider Demographics
NPI:1750460879
Name:JOHNSON, SHERRY ELIZABETH (BS, RN MS PHD)
Entity Type:Individual
Prefix:DR
First Name:SHERRY
Middle Name:ELIZABETH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:BS, RN MS PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CORDWAINER DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1671
Mailing Address - Country:US
Mailing Address - Phone:781-878-6543
Mailing Address - Fax:781-871-0306
Practice Address - Street 1:200 CORDWAINER DR
Practice Address - Street 2:SUITE 202
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1671
Practice Address - Country:US
Practice Address - Phone:781-878-6543
Practice Address - Fax:781-871-0306
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA171110163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPN0004OtherBC/BS
MAPN0004OtherBC/BS