Individual
JESSICA JOHANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2200 FORT JESSE RD, 110, NORMAL, IL 61761-6286
(309) 661-6290
(309) 451-1354
Mailing address
2200 FORT JESSE RD, 110, NORMAL, IL 61761-6286
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
041-361153
IL
Other
Enumeration date
08/15/2012
Last updated
10/04/2013
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