Provider Demographics
NPI:1942954367
Name:JOHNSON, SHANNA PATRICIA
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:PATRICIA
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 1:7151 E RANCHO VISTA DR UNIT 1012
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-1588
Mailing Address - Country:US
Mailing Address - Phone:503-970-9582
Mailing Address - Fax:
Practice Address - Street 1:7151 E RANCHO VISTA DR UNIT 1012
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-1588
Practice Address - Country:US
Practice Address - Phone:503-970-9582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN148985363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care