Individual
NICHOLAS JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
APN
Contact information
Practice address
8455 S LUELLA AVE, CHICAGO, IL 60617-1953
(773) 727-5355
Mailing address
8455 S LUELLA AVE, CHICAGO, IL 60617-1953
(773) 727-5355
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
209021402
IL
Other
Enumeration date
09/23/2020
Last updated
09/23/2020
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