Individual
SHANNON JOHNSTAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2501 E 104TH AVE, THORNTON, CO 80233-4401
(303) 255-4100
Mailing address
2200 MARKET ST, APT 415, DENVER, CO 80205-2064
(218) 590-0246
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1192657
CO
363AM0700X
Medical Physician Assistant
PA.0007121
CO
363AM0700X
Medical Physician Assistant
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Other
Enumeration date
11/18/2021
Last updated
01/17/2022
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