Healthcare Provider Details

I. General information

NPI: 1710723697
Provider Name (Legal Business Name): BROOKE KEDZIE JOHNSON DNP, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 N BARRINGTON RD
HOFFMAN ESTATES IL
60169-1019
US

IV. Provider business mailing address

1555 N BARRINGTON RD
HOFFMAN ESTATES IL
60169-1019
US

V. Phone/Fax

Practice location:
  • Phone: 847-843-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number209028404
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: