Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 036088253 | IL |
NPI | 1043235450 |
---|---|
Provider Name | Victoria J Johnson |
First Address | Urbana, IL 61801-2500 |
Second Address | Urbana, IL 61801 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 26/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0533210001 | DMERC (01) | IL |
250005082 | RAILROAD (01) | IL |
F83741 | (02) | |
F83741 | (02) | IL |