Individual
MADDIE R JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
509 W UNIVERSITY AVE, URBANA, IL 61801-1645
(217) 383-6636
(217) 383-3466
Mailing address
611 W PARK ST, URBANA, IL 61801-2529
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209018800
IL
Other
Enumeration date
07/23/2019
Last updated
07/23/2019
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