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NPI Code Detail

MEDICARE: DE'SHARRAH JOHNSON CHW

MEDICARE: DE'SHARRAH JOHNSON CHW
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
1172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1942144266
Entity Type Code : Individual
Provider Name (Legal Business Name) : DE'SHARRAH JOHNSON CHW
Provider Business Mailing Address
First Line : 808 WILDWOOD AVE
Second Line :
City : JACKSON
State : MI
Zip : 49202-4219
Country : US
Telephone Number : 517-257-7262
Fax Number :
Provider Business Practice Location Address
First Line : 505 N JACKSON ST
Second Line :
City : JACKSON
State : MI
Zip : 49201-1266
Country : US
Telephone Number : 517-748-5500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2026
Last Update Date : 04/16/2026

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Directions to “ DE'SHARRAH JOHNSON CHW” Practice Location

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