Healthcare Provider Details

I. General information

NPI: 1740333483
Provider Name (Legal Business Name): KERIANNE EVANS JOHNSON APN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 12/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 S MICHIGAN AVE
CHICAGO IL
60603-3200
US

IV. Provider business mailing address

1000 E WASHINGTON
SPRINGFIELD IL
62703
US

V. Phone/Fax

Practice location:
  • Phone: 312-592-6800
  • Fax: 312-592-6801
Mailing address:
  • Phone: 217-544-2744
  • Fax: 217-544-2746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209005205
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: