MEDICARE: MRS. SHERISSE YVONNE JOHNSTON CNM

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	163W00000X	Registered Nurse	RN235338	OH
2	367A00000X	Advanced Practice Midwife	NM03561	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578626057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHERISSE YVONNE JOHNSTON CNM

Provider Business Mailing Address
First Line	:	3059 BIERCE CIR
Second Line	:
City	:	TWINSBURG
State	:	OH
Zip	:	44087-3204
Country	:	US
Telephone Number	:	330-405-8929
Fax Number	:

Provider Business Practice Location Address
First Line	:	13944 EUCLID AVE
Second Line	:
City	:	EAST CLEVELAND
State	:	OH
Zip	:	44112-3832
Country	:	US
Telephone Number	:	216-767-4242
Fax Number	:

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

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	06/05/2012

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