Healthcare Provider Details

I. General information

NPI: 1831616770
Provider Name (Legal Business Name): SARA LYNN JOHNSON APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2017
Last Update Date: 08/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544 W PERSHING RD
DECATUR IL
62526-3226
US

IV. Provider business mailing address

324 KINGS MANTLE CT
MT ZION IL
62549-9725
US

V. Phone/Fax

Practice location:
  • Phone: 217-872-2400
  • Fax:
Mailing address:
  • Phone: 641-485-8398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number209.016335
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: