Individual
SHIRLEY K JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP, PNP
Contact information
Practice address
200 HAWKINS DR, IOWA CITY, IA 52242-1009
(319) 467-5384
Mailing address
200 HAWKINS DR, IOWA CITY, IA 52242-1009
(319) 467-5384
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
R143918-8
MN
363L00000X
Nurse Practitioner
R143918-8
MN
363LP0200X
Pediatric Nurse Practitioner
Primary
C077838
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
322100800
—
MN
01
—
500008374
RAILROAD MEDICARE
MN
05
—
ENROLLED
—
IA
05
—
ENROLLED
—
WI
Enumeration date
01/19/2006
Last updated
03/17/2018
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