Individual
SHAILEEN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
1304 N GRAND AVE, PUEBLO, CO 81003-2718
(719) 562-2360
Mailing address
1304 N GRAND AVE, PUEBLO, CO 81003-2718
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
0996289
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
—
Enumeration date
02/02/2021
Last updated
07/08/2021
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