Individual
MICHELLE D JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
8940 N WOOD SAGE RD, PEORIA, IL 61615-7822
(309) 243-3000
(309) 243-3040
Mailing address
8940 N WOOD SAGE RD, PEORIA, IL 61615-7822
(309) 243-3000
(309) 243-3040
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209011812
IL
363LA2100X
Acute Care Nurse Practitioner
209011812
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209.011812
LICENSE
IL
Enumeration date
09/05/2014
Last updated
03/02/2026
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