Provider Demographics
NPI:1922237809
Name:JOHNSON, SHAWNA AKIKO HIRATA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SHAWNA
Middle Name:AKIKO HIRATA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SHAWNA
Other - Middle Name:A
Other - Last Name:HIRATA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4290 POLK AVENUE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105
Mailing Address - Country:US
Mailing Address - Phone:619-563-0250
Mailing Address - Fax:858-633-4681
Practice Address - Street 1:4290 POLK AVENUE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105
Practice Address - Country:US
Practice Address - Phone:619-563-0250
Practice Address - Fax:858-633-4681
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95002518363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily