Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 036119477 | IL |
N | 207VG0400X | Gynecologist | 036119477 | IL |
NPI | 1629069919 |
---|---|
Provider Name | Dr. Lisa L Johnson |
First Address | Oak Lawn, IL 60453-2362 |
Second Address | Oak Lawn, IL 60453-2362 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2005 |
Last Update Date | 21/12/2021 |