Individual
MORIAH JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN-FNP-C
Contact information
Practice address
5405 N KNOXVILLE AVE, PEORIA, IL 61614-5016
(309) 691-4410
Mailing address
5405 N KNOXVILLE AVE, PEORIA, IL 61614-5016
(309) 691-4410
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209019632
IL
Other
Enumeration date
01/03/2020
Last updated
03/11/2020
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