Individual
BETHANY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
4241 HIGHWAY 14 W, CHRISTOPHER, IL 62822-1037
(618) 724-2401
Mailing address
103 COMMERCE ST, CARMI, IL 62821-2223
(618) 384-5686
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043108877
IL
Other
Enumeration date
02/01/2016
Last updated
02/01/2016
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