MEDICARE: MS. SHARON LANG JOHNSON RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WL0100X	Lactation Consultant (Registered Nurse)	494077	CA

General Provider Information

NPI Number	:	1124748447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHARON LANG JOHNSON RN

Provider Business Mailing Address
First Line	:	4651 LONG BRANCH AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92107
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4651 LONG BRANCH AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92107
Country	:	US
Telephone Number	:	619-997-5005
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2022
Last Update Date	:	08/29/2022

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