Shawanda L Johnson

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

167879 Issued in OH

Practice address

3782 Heatherstone Dr
Dayton, OH 45417-7003

Phone

(937) 684-6940

NPI assigned

Apr 17, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1523923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523923200000",
    "number": "1154818086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3782 HEATHERSTONE DR",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454177003",
            "telephone_number": "937-684-6940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3782 HEATHERSTONE DR",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454177003",
            "telephone_number": "937-684-6940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "SHAWANDA",
        "middle_name": "L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-04-17",
        "last_updated": "2018-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "OH",
            "license": "167879",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DODD PROVIFER",
            "identifier": "5714756",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rebecca Joy Russo Johnson, LISW
• Rebekah Johnson
• Richard E. Johnson Jr.
• Samantha Johnson, CDCA/PEER SUPPORT
• Savannah Marie Johnson
• Shereca Johnson
• Shirley Ann Johnson, OHIO LICDC-CSAND LSW
• Stephanie Fantauzzo Johnson, OTRL
• Taiya Johnson, LVN, CDCA
• Taylor Johnson

• Licensed Practical Nurse in Dayton, OH
• Providers in Dayton, OH by specialty
• Licensed Practical Nurse in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.