Healthcare Provider Details

I. General information

NPI: 1023621760
Provider Name (Legal Business Name): HEATHER N JOHNSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER EHMEN

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13486 SPRINGHILL CT APT SUITE
WINNEBAGO IL
61088-8054
US

IV. Provider business mailing address

13486 SPRINGHILL CT APT SUITE
WINNEBAGO IL
61088-8054
US

V. Phone/Fax

Practice location:
  • Phone: 815-262-8995
  • Fax:
Mailing address:
  • Phone: 815-262-8995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209021652
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209021652
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: