Provider Demographics
NPI:1447998166
Name:JOHNSON, SHANICE MOSLEY (RN, BSN, MSN-FNP-C)
Entity type:Individual
Prefix:
First Name:SHANICE
Middle Name:MOSLEY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN, BSN, MSN-FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 AMAZING PL NW
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:IA
Mailing Address - Zip Code:50009-1059
Mailing Address - Country:US
Mailing Address - Phone:515-505-2937
Mailing Address - Fax:
Practice Address - Street 1:1201 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50316-2339
Practice Address - Country:US
Practice Address - Phone:515-505-2937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA168896363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care