Provider Demographics
NPI:1568288934
Name:JOHNSON, SIERRA M (RN)
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103082 WUERTZBURG RD
Mailing Address - Street 2:
Mailing Address - City:ABBOTSFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54405-5708
Mailing Address - Country:US
Mailing Address - Phone:715-560-1069
Mailing Address - Fax:
Practice Address - Street 1:103082 WUERTZBURG RD
Practice Address - Street 2:
Practice Address - City:ABBOTSFORD
Practice Address - State:WI
Practice Address - Zip Code:54405-5708
Practice Address - Country:US
Practice Address - Phone:715-560-1069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI111712830163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse