MEDICARE: SHALAYNA LYNISE 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	376K00000X	Nurse's Aide	400420281004	OH

General Provider Information

NPI Number	:	1477129989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHALAYNA LYNISE JOHNSON

Provider Business Mailing Address
First Line	:	1665 BROWNSTONE BLVD APT 3
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-1308
Country	:	US
Telephone Number	:	419-466-5094
Fax Number	:

Provider Business Practice Location Address
First Line	:	1665 BROWNSTONE BLVD APT 3
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-1308
Country	:	US
Telephone Number	:	419-466-5094
Fax Number	:

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

Provider Enumeration Date	:	06/03/2021
Last Update Date	:	06/03/2021

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Directions to “ SHALAYNA LYNISE JOHNSON ” Practice Location

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