MEDICARE: MS. SHARICUS R 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	163W00000X	Registered Nurse	161817-30	WI

General Provider Information

NPI Number	:	1770809782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHARICUS R JOHNSON RN

Provider Business Mailing Address
First Line	:	3828 N 38TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-3014
Country	:	US
Telephone Number	:	414-215-0539
Fax Number	:

Provider Business Practice Location Address
First Line	:	3828 N 38TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-3014
Country	:	US
Telephone Number	:	414-215-0539
Fax Number	:

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

Provider Enumeration Date	:	04/15/2010
Last Update Date	:	04/15/2010

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