Individual
MIKA LYNN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, CNP
Contact information
Practice address
1051 W SOUTH ST, KEWANEE, IL 61443-8354
(815) 454-2811
(815) 454-2832
Mailing address
1051 W SOUTH ST, KEWANEE, IL 61443-8354
(815) 454-2811
(815) 454-2832
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
209015838
IL
363LA2100X
Acute Care Nurse Practitioner
277001258
IL
363LG0600X
Gerontology Nurse Practitioner
Primary
277001258
IL
Other
Enumeration date
08/21/2013
Last updated
08/23/2024
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