Healthcare Provider Details

I. General information

NPI: 1164832705
Provider Name (Legal Business Name): ELIZABETH JANE JOHNS ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2014
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 MEMORIAL DR DIV MEDICAL ONCOLOGY
BELLEVILLE IL
62226-5360
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 800-647-2098
  • Fax: 314-362-3192
Mailing address:
  • Phone: 800-647-2098
  • Fax: 314-362-3192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209011512
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number209011512
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: