Healthcare Provider Details

I. General information

NPI: 1841266095
Provider Name (Legal Business Name): SHARON JOHNSTON CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 04/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 STONE ST
PORT HURON MI
48060-3520
US

IV. Provider business mailing address

3050 COMMERCE DR SUITE B
FORT GRATIOT MI
48059-3819
US

V. Phone/Fax

Practice location:
  • Phone: 810-984-1000
  • Fax: 810-984-3138
Mailing address:
  • Phone: 810-385-4441
  • Fax: 810-385-1540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number4704063050
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: