Individual
NADENE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.T., M.M.P.
Contact information
Practice address
1917 E GATE PKWY, ROCKFORD, IL 61108-5915
(815) 243-0341
Mailing address
1917 E GATE PKWY, ROCKFORD, IL 61108-5915
(815) 243-0341
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
227007520
IL
Other
Enumeration date
09/16/2011
Last updated
09/16/2011
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