Healthcare Provider Details

I. General information

NPI: 1760730576
Provider Name (Legal Business Name): MEGAN M JOHNSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 CADILLAC CT STE 6
BELVIDERE IL
61008-1733
US

IV. Provider business mailing address

1976 SHAW WOODS DR
ROCKFORD IL
61107-1730
US

V. Phone/Fax

Practice location:
  • Phone: 815-494-8459
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041266536
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277004235
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: