Individual
SHATONNA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
318 MIRIAM AVE, ROCKFORD, IL 61101-5534
(779) 208-6179
(779) 208-6179
Mailing address
1930 N ALPINE RD, ROCKFORD, IL 61107-1416
(779) 208-6179
(779) 208-6179
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
—
IL
Other
Enumeration date
12/11/2017
Last updated
12/11/2017
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