Provider Demographics
NPI:1760754931
Name:JOHNSON-EBY, SHARON DENICE (RRT)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:DENICE
Last Name:JOHNSON-EBY
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9354 ENSIGN AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55438-1455
Mailing Address - Country:US
Mailing Address - Phone:952-261-3542
Mailing Address - Fax:
Practice Address - Street 1:9354 ENSIGN AVE S
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55438-1455
Practice Address - Country:US
Practice Address - Phone:952-261-3542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-03
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN29942279C0205X
MN2019171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No2279C0205XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredCritical Care