Individual
MS. JANISE LACHELLE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2474 RENOIS LN, CAHOKIA, IL 62206-3015
(618) 799-2454
Mailing address
2474 RENOIS LN, CAHOKIA, IL 62206-3015
(618) 799-2454
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043115886
IL
164W00000X
Licensed Practical Nurse
2013021137
MO
183700000X
Pharmacy Technician
049.211871
IL
183700000X
Pharmacy Technician
2013012431
MO
Other
Enumeration date
05/22/2015
Last updated
05/22/2015
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