Individual
JOYCE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
102 S HENNEPIN AVE, DIXON, IL 61021
(815) 285-8520
(815) 285-8903
Mailing address
102 S HENNEPIN AVE, DIXON, IL 61021-3083
(815) 285-8908
(815) 285-8903
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
036-137459
IL
207Q00000X
Family Medicine Physician
Primary
036-137459
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036137459
—
IL
01
—
F400248216
MEDICARE
IL
01
—
F400269703
MEDICARE
IL
Enumeration date
07/17/2012
Last updated
11/12/2024
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