Individual
VENDELA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1875 DEMPSTER ST STE 265, PARK RIDGE, IL 60068-1126
(847) 723-1550
Mailing address
29373 NETWORK PL, CHICAGO, IL 60673-1293
(847) 390-5900
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-010586
IL
363AS0400X
Surgical Physician Assistant
085-010586
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/17/2024
Last updated
02/28/2025
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