Individual
SHELLY L JOHNSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3509 DEWEY ST, MANITOWOC, WI 54220
(920) 686-5731
Mailing address
3509 DEWEY ST, MANITOWOC, WI 54220-5813
(920) 686-5731
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
45814020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13487
DEAN HEALTH PLAN HMO
—
05
—
1922016690
—
WI
Enumeration date
08/04/2006
Last updated
09/04/2018
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