Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 209.016862 | IL |
Y | 363LA2200X | Nurse Practitioner - Adult Health | 209016862 | IL |
NPI | 1043728892 |
---|---|
Provider Name | Cynthia Lynn Johnson |
First Address | Maywood, IL 60153-3328 |
Second Address | Maywood, IL 60153-3328 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2018 |
Last Update Date | 12/04/2021 |