Provider Demographics
NPI:1336748631
Name:JOHNSON, SHARRON
Entity type:Individual
Prefix:
First Name:SHARRON
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHARRON
Other - Middle Name:B
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SHARRON B JOHNSON
Mailing Address - Street 1:3095 BRANDI LN
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:OH
Mailing Address - Zip Code:45106-9382
Mailing Address - Country:US
Mailing Address - Phone:513-680-6076
Mailing Address - Fax:
Practice Address - Street 1:3095 BRANDI LN
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:OH
Practice Address - Zip Code:45106-9382
Practice Address - Country:US
Practice Address - Phone:513-680-6076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0078832253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care