Individual
HEIDI JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
7717 N ORANGE PRAIRIE RD, PEORIA, IL 61615-9323
(309) 589-6800
Mailing address
919 N BROAD ST, GALESBURG, IL 61401-2724
(360) 865-1459
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
041414240
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041414240
ILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION
IL
Enumeration date
02/15/2018
Last updated
02/15/2018
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