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Individual

MS. CHRISTINE JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
APN

Contact information

Practice address
8311 ROOSEVELT RD, FOREST PARK, IL 60130-2529
(708) 771-7000
Mailing address
4007 JUNEBERRY RD, NAPERVILLE, IL 60564-7153
(815) 557-9191

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
209008950
IL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
209008950
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
IL5686035
MEDICARE PTAN
IL
05
PAYEE 2
IL
Enumeration date
08/17/2011
Last updated
06/14/2022
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