Individual
JENNIFER JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
303 W OGDEN AVE FL 2, WESTMONT, IL 60559-1419
(630) 790-1872
(630) 968-3762
Mailing address
PO BOX 713260, CHICAGO, IL 60677-1260
(630) 469-9200
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085001394
IL
363AS0400X
Surgical Physician Assistant
085001394
IL
363AS0400X
Surgical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
085001394
—
IL
01
—
970023362
RAILROAD MEDICARE
IL
Enumeration date
09/27/2005
Last updated
07/19/2023
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