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Individual

MRS. SHONDA DEANA JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
200 PATEWOOD DR FL 4, GREENVILLE, SC 29615-3593
(864) 454-5612
(864) 454-5121
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
26263
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
PENDING
SC
Enumeration date
11/28/2021
Last updated
10/14/2022
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