Individual
MRS. EBONY TALISE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BSN-RN
Contact information
Practice address
1216 WEST 97TH PLACE, CHICAGO, IL 60643
(708) 543-0632
Mailing address
1216 W 97TH PL, CHICAGO, IL 60643-1420
(708) 543-0632
Taxonomy
Speciality
Code
Description
License number
State
163WC1600X
Continuing Education/Staff Development Registered Nurse
041418831
IL
163WI0500X
Infusion Therapy Registered Nurse
041418831
IL
163WI0500X
Infusion Therapy Registered Nurse
28293616A
IN
163WS0200X
School Registered Nurse
041418831
IL
251F00000X
Home Infusion Agency
Primary
041418831
IL
251F00000X
Home Infusion Agency
28293616A
IN
261QI0500X
Infusion Therapy Clinic/Center
041418831
IL
Other
Enumeration date
02/11/2025
Last updated
02/11/2025
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