MEDICARE: MS. SHAMIRA CLINTONIA JOHNSON CNA

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	376K00000X	Nurse's Aide	10019808	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10019808	OTHER	PA	NURSES AIDE REGISTRY
2	6754270	OTHER	PA	STATE ENTITY NUMBER

General Provider Information

NPI Number	:	1134609464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHAMIRA CLINTONIA JOHNSON CNA

Provider Business Mailing Address
First Line	:	2 W 9TH ST
Second Line	:
City	:	CHESTER
State	:	PA
Zip	:	19013-4206
Country	:	US
Telephone Number	:	610-803-5484
Fax Number	:	610-874-5837

Provider Business Practice Location Address
First Line	:	2 W 9TH ST
Second Line	:
City	:	CHESTER
State	:	PA
Zip	:	19013-4206
Country	:	US
Telephone Number	:	610-803-5484
Fax Number	:	610-874-5837

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

Provider Enumeration Date	:	08/16/2018
Last Update Date	:	06/12/2026

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