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General NPI Number Information
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NPI Number | 1275770992
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Entity Type | Individual
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Provider Name | JILL LYNNE JOHNSON LMT
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Gender | Female
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Dates
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Enumeration Date | 01/16/2009
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Last Update Date | 01/16/2009
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Provider Practice Location Address
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Address Line | 305 JOE DR E
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City | AMBOY
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State | IL
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Zip | 61310-9492
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Country | US
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Telephone | 815-857-2458
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Fax | 815-857-2749
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Provider Business Mailing Address
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Address Line | PO BOX 145
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City | AMBOY
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State | IL
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Zip | 61310-0145
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Country | US
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Telephone | 815-857-2458
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Fax | 815-857-2749
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 227.002367
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License Number State | IL
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