Healthcare Provider Details

I. General information

NPI: 1447169644
Provider Name (Legal Business Name): GRETCHEN WOJTAS-JOHNSON DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GRETCHEN WOJTAS RN

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 FAIRWAY DR
FREEPORT IL
61032-6600
US

IV. Provider business mailing address

4753 N CONRAD RD
FORRESTON IL
61030-9421
US

V. Phone/Fax

Practice location:
  • Phone: 815-599-6000
  • Fax:
Mailing address:
  • Phone: 815-742-1655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209036521
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: