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General NPI Number Information
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NPI Number | 1407039167
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Entity Type | Individual
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Provider Name | MICHELE DAWN JOHNSON APN
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Gender | Female
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Dates
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Enumeration Date | 12/17/2007
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Last Update Date | 11/17/2021
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Provider Practice Location Address
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Address Line | 3775 N MULFORD RD
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City | ROCKFORD
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State | IL
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Zip | 61114-5632
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Country | US
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Telephone | 815-636-6400
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Fax |
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Provider Business Mailing Address
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Address Line | 8870 POLARIS DR
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City | MACHESNEY PARK
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State | IL
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Zip | 61115-2258
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Country | US
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Telephone | 815-877-1340
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Fax |
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 209.006878
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License Number State | IL
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