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General NPI Number Information
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NPI Number | 1194549113
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Entity Type | Individual
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Provider Name | TANISHA JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 11/15/2024
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 2357 W MASON ST
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City | GREEN BAY
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State | WI
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Zip | 54303-4708
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Country | US
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Telephone | 920-337-6740
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Fax |
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Provider Business Mailing Address
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Address Line | 9009 CAROTHERS PKWY STE C1
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City | FRANKLIN
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State | TN
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Zip | 37067-1704
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Country | US
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Telephone | 615-538-7739
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 326698
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License Number State | WI
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