Healthcare Provider Details

I. General information

NPI: 1629997366
Provider Name (Legal Business Name): SHIRLONDA RENEE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2513 BISMARCK ST
SAGINAW MI
48601-1201
US

IV. Provider business mailing address

1314 S 16TH ST
SAGINAW MI
48601-2216
US

V. Phone/Fax

Practice location:
  • Phone: 989-355-5090
  • Fax:
Mailing address:
  • Phone: 989-205-1194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: