Provider Demographics
NPI:1386932804
Name:JOHNSON, MARK SHAWN (RN)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:SHAWN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5946 COURTNEY PL
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-4402
Mailing Address - Country:US
Mailing Address - Phone:513-276-9537
Mailing Address - Fax:
Practice Address - Street 1:5946 COURTNEY PL
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-4402
Practice Address - Country:US
Practice Address - Phone:513-276-9537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.349624163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse