Healthcare Provider Details

I. General information

NPI: 1447171921
Provider Name (Legal Business Name): ROBERT CASPER JOHNSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 WILLOW SPRINGS RD STE 380
LA GRANGE HIGHLANDS IL
60525-6539
US

IV. Provider business mailing address

5201 WILLOW SPRINGS RD STE 380
LA GRANGE HIGHLANDS IL
60525-6539
US

V. Phone/Fax

Practice location:
  • Phone: 708-354-2550
  • Fax:
Mailing address:
  • Phone: 708-354-2550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209036176
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: