Individual
MATTHEW RUSSELL JOHNSOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
EMT
Contact information
Practice address
12318 EMPIRE ST, LOVES PARK, IL 61111-8957
(815) 378-4556
Mailing address
12318 EMPIRE ST, LOVES PARK, IL 61111-8957
(815) 378-4556
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
Primary
—
—
Other
Enumeration date
05/25/2026
Last updated
05/25/2026
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