Healthcare Provider Details

I. General information

NPI: 1952352205
Provider Name (Legal Business Name): DENISE LYNNE JOHNSON PRITCHETT FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 08/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1285 FRANCISCAN DR
LITCHFIELD IL
62056
US

IV. Provider business mailing address

1285 FRANCISCAN DR
LITCHFIELD IL
62056-1778
US

V. Phone/Fax

Practice location:
  • Phone: 217-324-1008
  • Fax: 217-324-5959
Mailing address:
  • Phone: 217-324-1008
  • Fax: 217-324-5959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209001725
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: