Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | 036.137545 | IL |
NPI | 1093071680 |
---|---|
Provider Name | Jessica Danielle Johnson |
First Address | Maywood, IL 60153-3328 |
Second Address | Elk Grove Village, IL 60007-3367 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2012 |
Last Update Date | 12/04/2021 |