Individual
ELIZABETH JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7409 EAGLE CREST BLVD STE G, EVANSVILLE, IN 47715-9136
(812) 842-4020
(812) 842-4019
Mailing address
7409 EAGLE CREST BLVD STE G, EVANSVILLE, IN 47715-9136
(812) 842-4020
(812) 842-4019
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
041340671
IL
363LF0000X
Family Nurse Practitioner
Primary
71011040A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
71011040A
STATE MEDICAL LICENSE #
IN
01
—
CA2264
RR MEDICARE - GROUP #
—
01
—
P00433892
RR MEDICARE INDIVIDUAL #
—
Enumeration date
08/23/2006
Last updated
09/17/2021
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