Healthcare Provider Details

I. General information

NPI: 1184696544
Provider Name (Legal Business Name): BARBARA L JOHNSTON NP APN RN MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 09/08/2020
Certification Date: 09/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2338 N. VAN WINKLE WAY SUITE 2200
PEORIA IL
61615
US

IV. Provider business mailing address

215 W STRATFORD DR
PEORIA IL
61614-7346
US

V. Phone/Fax

Practice location:
  • Phone: 309-692-6088
  • Fax: 309-692-0502
Mailing address:
  • Phone: 309-472-6475
  • Fax: 309-673-6914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number209005123
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: