Organization
YVETTE M JOHNSON LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
YVETTE JOHNSON (PRINCIPAL)
(708) 785-7094
Entity
Organization
Contact information
Practice address
1944 W 163RD ST, MARKHAM, IL 60428-5647
(708) 785-7094
Mailing address
1944 W 163RD ST, MARKHAM, IL 60428-5647
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
209.014010
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209.014010
LICENSE
IL
Enumeration date
02/19/2017
Last updated
02/19/2017
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