Healthcare Provider Details

I. General information

NPI: 1104951409
Provider Name (Legal Business Name): SHARON A JOHNSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 W WASHINGTON ST
RENSSELAER IN
47978-2820
US

IV. Provider business mailing address

124 W WASHINGTON ST
RENSSELAER IN
47978-2820
US

V. Phone/Fax

Practice location:
  • Phone: 219-866-4135
  • Fax: 219-866-0803
Mailing address:
  • Phone: 219-866-4135
  • Fax: 219-866-0803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71001610A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: