Individual
DAVID E JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ANP
Contact information
Practice address
6812 STATE ROUTE 162 STE 21, MARYVILLE, IL 62062-8565
(618) 288-5566
(618) 288-4005
Mailing address
6810 STATE ROUTE 162 BOX 215, MARYVILLE, IL 62062-8501
(618) 391-6405
(618) 288-4088
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209-004434
IL
Other
Enumeration date
10/19/2007
Last updated
08/28/2024
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