Basic Information
| Provider Information | |||||||||
| NPI: | 1124589957 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHARON A JOHNSON FNP LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1103 E GRACE ST | ||||||||
| Address2: | |||||||||
| City: | RENSSELAER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 479783210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2198668655 | ||||||||
| FaxNumber: | 2198660803 | ||||||||
| Practice Location | |||||||||
| Address1: | 1103 E GRACE ST | ||||||||
| Address2: | |||||||||
| City: | RENSSELAER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 479783210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2198668655 | ||||||||
| FaxNumber: | 2198660803 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2019 | ||||||||
| LastUpdateDate: | 03/26/2019 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | SHARON | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2198668655 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | FNP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.