| NPI | 1619180106 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN JOHNSON Family Nurse Practitioner 708-256-0816 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209009090) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2011-10-11 |