Johnson, Johnnie Dominica

Johnson, Johnnie Dominica is an individual health care provider with primary practice located at 3880 Salem Lake Dr Ste F , Long Grove IL 60047-5292. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Family, Physician Assistants & Advanced Practice Nursing Providers / Adult Health. Physician Assistants & Advanced Practice Nursing Providers / Adult Health is her primary health care specialty. Johnson, Johnnie Dominica can be contacted via phone (847) 719-2220.

Contact Information

Primary practice address
3880 Salem Lake Dr Ste F Long Grove IL 60047-5292
Phone: (847) 719-2220
Fax: (847) 719-2265
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 209012407 Illinois
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X 277001345 Illinois

Profile Details

NPI number 1043601057
LBN Legal business name Johnson, Johnnie Dominica
Credentials Family Nurse Practitioner (FNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 12th, 2015
Last updated Jul 25th, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1043601057 NPPES
Illinois MEDICAID 277001345

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