Healthcare Provider Details

I. General information

NPI: 1437073137
Provider Name (Legal Business Name): MARIAH SHARI JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7017 S EBERHART AVE
CHICAGO IL
60637-4611
US

IV. Provider business mailing address

7017 S EBERHART AVE
CHICAGO IL
60637-4611
US

V. Phone/Fax

Practice location:
  • Phone: 773-569-8519
  • Fax:
Mailing address:
  • Phone: 773-569-8519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209035070
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: