Provider Demographics
NPI:1336949619
Name:JOHNSON, SHAWNTINA (STNA)
Entity type:Individual
Prefix:
First Name:SHAWNTINA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3978 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45204-1023
Mailing Address - Country:US
Mailing Address - Phone:513-904-2922
Mailing Address - Fax:
Practice Address - Street 1:3978 RIVER RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45204-1023
Practice Address - Country:US
Practice Address - Phone:513-904-2922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH602246370624376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide