Doctor Name: | JOHNNIE DOMINICA JOHNSON |
NPI Number: | 1043601057 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 209012407 |
Business Practice Address: | 4900 Broadway Gary, IN - 464084605 |
Business Phone Number: | 2192375170 |
Business Fax Number: | 2193211931 |
Mailing Address: | 213n Racine Ave 100, CHICAGO |
State: | IL |
Postal Code: | 606071644 |
Phone Number: | 3127339730 |
Fax Number: | |
NPI Enumeration Date: | 02/12/2015 |
NPI Last Update Date: | 09/03/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 209012407 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |