=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750274320
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHANNON ELIZABETH JOHNS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2025
-----------------------------------------------------
Last Update Date | 07/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3333 BURNET AVE
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45229-3026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-636-4200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3815 LILAC LN
-----------------------------------------------------
City | AMELIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45102-1456
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-629-0048
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 0038470
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------