Individual
LATRAVIA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
6749 PINE LAKE DR, TINLEY PARK, IL 60477-4935
(708) 381-9315
Mailing address
6749 PINE LAKE DR, TINLEY PARK, IL 60477-4935
(708) 381-9315
Taxonomy
Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
Primary
0413737.21
IL
Other
Enumeration date
02/10/2026
Last updated
02/10/2026
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