Individual
SAMANTHA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
2650 RIDGE AVE, EVANSTON, IL 60201-1700
(847) 570-2040
Mailing address
2650 RIDGE AVE, EVANSTON, IL 60201-1700
(847) 570-2040
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209-009758
IL
363LF0000X
Family Nurse Practitioner
209-009758
IL
Other
Enumeration date
10/12/2012
Last updated
01/16/2024
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