Healthcare Provider Details

I. General information

NPI: 1881789949
Provider Name (Legal Business Name): LORI A. JOHNSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS LORI A. COURSON

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 N MERCHANT ST
EFFINGHAM IL
62401-2128
US

IV. Provider business mailing address

1106 N MERCHANT ST P.O. BOX 665
EFFINGHAM IL
62401-2128
US

V. Phone/Fax

Practice location:
  • Phone: 217-342-7000
  • Fax: 217-342-7002
Mailing address:
  • Phone: 217-342-7000
  • Fax: 217-342-7002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209-000472
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041-245291
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: