Individual
NICOLE RUTH JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4440 W 95TH ST STE 1200H, OAK LAWN, IL 60453-2600
(708) 684-5341
Mailing address
29373 NETWORK PL, CHICAGO, IL 60673-1293
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
125061008
IL
2080C0008X
Child Abuse Pediatrics Physician
Primary
036-137797
IL
Other
Enumeration date
06/21/2012
Last updated
04/25/2022
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