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General NPI Number Information
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NPI Number | 1457234007
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Entity Type | Individual
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Provider Name | SHANIQUE JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 07/30/2025
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Last Update Date | 10/23/2025
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Provider Practice Location Address
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Address Line | 45 LOWER WESTFIELD RD
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City | HOLYOKE
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State | MA
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Zip | 01040-2747
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Country | US
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Telephone | 413-315-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 104 YALE ST
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City | SPRINGFIELD
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State | MA
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Zip | 01109-3435
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Country | US
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Telephone | 413-517-7090
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN2319245
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License Number State | MA
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