MEDICARE: CHERYL JOHNSON

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	163W00000X	Registered Nurse	7417562-3102	UT

General Provider Information

NPI Number	:	1255627881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL JOHNSON

Provider Business Mailing Address
First Line	:	8267 SOUTH CHICKASAW LN
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84070-2048
Country	:	US
Telephone Number	:	408-616-0440
Fax Number	:

Provider Business Practice Location Address
First Line	:	8267 SOUTH CHICKASAW LN
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84070-2048
Country	:	US
Telephone Number	:	408-616-0440
Fax Number	:

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

Provider Enumeration Date	:	06/22/2011
Last Update Date	:	06/22/2011

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Directions to “ CHERYL JOHNSON ” Practice Location

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