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NPI Code Detail

MEDICARE: SHANAE L JOHNSON LPN

MEDICARE: SHANAE L JOHNSON LPN
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
1164W00000XLicensed Practical NurseLPN.190856OH

General Provider Information

NPI Number : 1972458297
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANAE L JOHNSON LPN
Provider Business Mailing Address
First Line : 625 CLEVELAND AVE NW
Second Line :
City : CANTON
State : OH
Zip : 44702-1805
Country : US
Telephone Number : 330-455-0374
Fax Number : 330-453-6716
Provider Business Practice Location Address
First Line : 601 CLEVELAND AVE NW
Second Line :
City : CANTON
State : OH
Zip : 44702-1836
Country : US
Telephone Number : 330-453-8252
Fax Number : 330-452-4655
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2026
Last Update Date : 03/02/2026

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Directions to “ SHANAE L JOHNSON LPN” Practice Location

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