Healthcare Provider Details

I. General information

NPI: 1922096601
Provider Name (Legal Business Name): LUANNE DEE JOHNSON NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LUANNE D PFEIFF FNPC

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 01/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 CENTER ST
AUGUSTA IL
62311-1228
US

IV. Provider business mailing address

PO BOX 160
CARTHAGE IL
62321-0160
US

V. Phone/Fax

Practice location:
  • Phone: 217-392-2108
  • Fax: 217-392-2110
Mailing address:
  • Phone: 217-357-2173
  • Fax: 217-357-6564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA060889
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: