MEDICARE: SHARON DENICE JOHNSON-EBY RRT

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	2279C0205X	Critical Care Registered Respiratory Therapist	2994	MN
2	171100000X	Acupuncturist	2019	MN

General Provider Information

NPI Number	:	1760754931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON DENICE JOHNSON-EBY RRT

Provider Business Mailing Address
First Line	:	9354 ENSIGN AVE S
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55438-1455
Country	:	US
Telephone Number	:	952-261-3542
Fax Number	:

Provider Business Practice Location Address
First Line	:	9354 ENSIGN AVE S
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55438-1455
Country	:	US
Telephone Number	:	952-261-3542
Fax Number	:

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

Provider Enumeration Date	:	02/03/2012
Last Update Date	:	04/30/2024

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