Individual
CATHY JOHANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.P.N.
Contact information
Practice address
151 N MAIN ST, DECATUR, IL 62523-1206
(217) 362-6262
(217) 362-6290
Mailing address
PO BOX 710, DECATUR, IL 62525-0710
(217) 362-6262
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043-060980
IL
Other
Enumeration date
06/21/2008
Last updated
06/21/2008
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