Individual
JOSHUA K JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
405 W JACKSON ST, CARBONDALE, IL 62901-1462
(618) 549-0721
(618) 529-0529
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(618) 549-0721
(618) 529-0529
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041292231
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
209007006
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2005017522
RN LICENSE
MO
01
—
214881
MULTISPECIALTY GROUP PTAN
IL
Enumeration date
12/24/2007
Last updated
06/04/2021
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