Individual
MRS. SHANTAE MONAE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGACNP-BC
Contact information
Practice address
100 MACK AVE FL 1, DETROIT, MI 48201-2416
(313) 818-8207
Mailing address
11331 HAZELTON, REDFORD, MI 48239-1429
(313) 231-6110
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
4704245204
MI
Other
Enumeration date
09/28/2016
Last updated
07/29/2025
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