Healthcare Provider Details

I. General information

NPI: 1548388044
Provider Name (Legal Business Name): RHONDA RAE JOHNSON CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 01/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N ROCKTON AVE PAC TEAM OFFICE - MAIN CLINIC
ROCKFORD IL
61103-3619
US

IV. Provider business mailing address

2300 N ROCKTON AVE PAC TEAM OFFICE - MAIN CLINIC
ROCKFORD IL
61103-3619
US

V. Phone/Fax

Practice location:
  • Phone: 815-971-2000
  • Fax: 815-971-9599
Mailing address:
  • Phone: 815-971-2000
  • Fax: 815-971-9599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number209004226
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: