Individual
SHANE REED JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
215 E HAWAII AVE, NAMPA, ID 83686-6011
(208) 463-3234
(208) 463-3044
Mailing address
217 W GEORGIA AVE, SUITE 115, NAMPA, ID 83686-6811
(208) 463-3234
(208) 463-3044
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA293
ID
363AS0400X
Surgical Physician Assistant
PA293
ID
Other
Enumeration date
01/13/2006
Last updated
12/18/2009
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