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Individual

MRS. SHANNON LEE JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
1228 E RUSHOLME ST, MOB 1, SUITE 3020, DAVENPORT, IA 52803
(563) 421-7540
(563) 421-7549
Mailing address
1228 E RUSHOLME ST, MOB 1, SUITE 3020, DAVENPORT, IA 52803
(563) 421-7540
(563) 421-7549

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
002328
IA
363A00000X
Physician Assistant
085003168
IL

Other

Enumeration date
01/09/2008
Last updated
10/12/2021
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