MEDICARE: SHELLEY L JOHNSON APNP

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	363LF0000X	Family Nurse Practitioner	1750603130	WI
2	363L00000X	Nurse Practitioner	3976	WI
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	2025070556	WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	K400194647	OTHER	WI	MEDICARE( FROEDTERT SOUTH)

Other Identifiers

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

General Provider Information

NPI Number	:	1750603130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLEY L JOHNSON APNP

Provider Business Mailing Address
First Line	:	4817 COPPER LEAF BLVD
Second Line	:
City	:	MOUNT PLEASANT
State	:	WI
Zip	:	53403-4100
Country	:	US
Telephone Number	:	307-331-0855
Fax Number	:	262-577-8412

Provider Business Practice Location Address
First Line	:	4817 COPPER LEAF BLVD
Second Line	:
City	:	MOUNT PLEASANT
State	:	WI
Zip	:	53403-4100
Country	:	US
Telephone Number	:	307-331-0855
Fax Number	:	262-577-8321

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

Provider Enumeration Date	:	02/25/2010
Last Update Date	:	03/12/2026

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Directions to “ SHELLEY L JOHNSON APNP” Practice Location

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