MEDICARE: SHARON RENEE JOHNSON-SCALES NP

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	363LF0000X	Family Nurse Practitioner	0024177420	VA

General Provider Information

NPI Number	:	1306557285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON RENEE JOHNSON-SCALES NP

Provider Business Mailing Address
First Line	:	1000 MOSBY ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23223-5005
Country	:	US
Telephone Number	:	804-337-9936
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 MOSBY ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23223-5005
Country	:	US
Telephone Number	:	804-337-9936
Fax Number	:

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

Provider Enumeration Date	:	12/12/2022
Last Update Date	:	12/12/2022

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