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Individual
REBECCA M. JOHNSON
Active
Individual
REBECCA M. JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.C.
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
016545-1
NY
363A00000X
Physician Assistant
085-002312
IL
363A00000X
Physician Assistant
085002312
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0739010001
MEDICARE NSC
IL
01
—
0739010005
MEDICARE NSC
IL
01
—
0739010006
MEDICARE NSC
IL
01
—
0739010008
MEDICARE NSC
IL
01
—
CD4744
RAILROAD MEDICARE GROUP #
IL
01
—
P00332367
RAILROAD MEDICARE
IL
01
—
P00332367
RAILROAD MEDICARE PIN #
—
Enumeration date
08/05/2006
Last updated
03/29/2021
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