Individual
FANNIE SHARIEE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MEDICAL ASISSITANT
Contact information
Practice address
19549 RANDOLPH PL, DENVER, CO 80249-8609
(720) 209-8897
Mailing address
19549 RANDOLPH PL, DENVER, CO 80249-8609
(720) 209-8897
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0021128
CO
164W00000X
Licensed Practical Nurse
0335945
CO
172V00000X
Community Health Worker
—
—
Other
Enumeration date
06/20/2008
Last updated
04/24/2023
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