Individual
DANIELLE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1800 BROADWAY ST, PEKIN, IL 61554-3822
(309) 346-3416
Mailing address
5100 RELIABLE PKWY, CHICAGO, IL 60686-0051
(309) 672-4809
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085003985
IL
Other
Enumeration date
02/11/2011
Last updated
02/11/2011
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