Provider Demographics
NPI:1639306871
Name:JOHNSON, TYSHEENE SHAMONE (CNA)
Entity type:Individual
Prefix:MRS
First Name:TYSHEENE
Middle Name:SHAMONE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 S FRASER WAY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-5726
Mailing Address - Country:US
Mailing Address - Phone:303-481-8694
Mailing Address - Fax:
Practice Address - Street 1:1535 S FRASER WAY
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-5726
Practice Address - Country:US
Practice Address - Phone:303-481-8694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO511177376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO3227108Medicare PIN