MEDICARE: SHIRLEY HARRIS JOHNSON RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WA0400X	Addiction (Substance Use Disorder) Registered Nurse	26NO12364300	NJ

General Provider Information

NPI Number	:	1043167307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIRLEY HARRIS JOHNSON RN

Provider Business Mailing Address
First Line	:	700 NEWARK AVE APT 312
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-2812
Country	:	US
Telephone Number	:	201-451-5425
Fax Number	:	201-451-7499

Provider Business Practice Location Address
First Line	:	700 NEWARK AVE APT 312
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-2812
Country	:	US
Telephone Number	:	201-451-5425
Fax Number	:	201-451-7499

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2026
Last Update Date	:	03/14/2026

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