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General NPI Number Information
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NPI Number | 1922813401
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Entity Type | Individual
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Provider Name | EBONY TALISE JOHNSON BSN-RN
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Gender | Female
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Dates
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Enumeration Date | 02/11/2025
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 1216 WEST 97TH PLACE
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City | CHICAGO
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State | IL
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Zip | 60643
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Country | US
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Telephone | 708-543-0632
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Fax |
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Provider Business Mailing Address
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Address Line | 1216 W 97TH PL
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City | CHICAGO
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State | IL
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Zip | 60643-1420
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Country | US
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Telephone | 708-543-0632
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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 | 163WS0200X
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Taxonomy Name | School Registered Nurse
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License Number | 041418831
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number | 28293616A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number | 041418831
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number | 041418831
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 163WC1600X
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Taxonomy Name | Continuing Education/Staff Development Registered Nurse
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License Number | 041418831
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License Number State | IL
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Taxonomy #6
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Taxonomy Code | 163WI0500X
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Taxonomy Name | Infusion Therapy Registered Nurse
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License Number | 28293616A
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License Number State | IN
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Taxonomy #7
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Taxonomy Code | 163WI0500X
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Taxonomy Name | Infusion Therapy Registered Nurse
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License Number | 041418831
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License Number State | IL
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