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NPI Code Detail

MEDICARE: SHAUN ELAINE JOHNSON

MEDICARE: SHAUN ELAINE 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
1174H00000XHealth Educator

General Provider Information

NPI Number : 1861288185
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAUN ELAINE JOHNSON
Provider Business Mailing Address
First Line : 21651 E COUNTRY VISTA DR STE C21651E
Second Line :
City : LIBERTY LAKE
State : WA
Zip : 99019-7708
Country : US
Telephone Number : 509-928-0454
Fax Number :
Provider Business Practice Location Address
First Line : 21651 E COUNTRY VISTA DR STE C
Second Line :
City : LIBERTY LAKE
State : WA
Zip : 99019-7709
Country : US
Telephone Number : 509-928-0454
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/15/2025
Last Update Date : 04/15/2025

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Directions to “ SHAUN ELAINE JOHNSON ” Practice Location

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