Provider Demographics
NPI:1710776893
Name:JOHNSON, SHAUNITA R
Entity type:Individual
Prefix:
First Name:SHAUNITA
Middle Name:R
Last Name:JOHNSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3223 SEWARD ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68111-4263
Mailing Address - Country:US
Mailing Address - Phone:402-594-6130
Mailing Address - Fax:
Practice Address - Street 1:3223 SEWARD ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68111-4263
Practice Address - Country:US
Practice Address - Phone:402-594-6130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider