| Doctor Name: | BRIAN D JOHNSON |
| NPI Number: | 1043585573 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | FNP-BC |
| License Number: | 209009443 |
| Business Practice Address: | 841 N Galena Ave Suite 200 Dixon, IL - 610211568 |
| Business Phone Number: | 8152852273 |
| Business Fax Number: | 8152852276 |
| Mailing Address: | 841 N Galena Ave, Suite 200 DIXON |
| State: | IL |
| Postal Code: | 610211568 |
| Phone Number: | 8152852273 |
| Fax Number: | 8152852276 |
| NPI Enumeration Date: | 03/16/2012 |
| NPI Last Update Date: | 01/20/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP2300X |
| License Number: | 209009443 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |