Provider Demographics
NPI:1043608631
Name:JOHNSON, YVETTE M (APN)
Entity Type:Individual
Prefix:
First Name:YVETTE
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 W 155TH STREET
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:IL
Mailing Address - Zip Code:60426
Mailing Address - Country:US
Mailing Address - Phone:708-596-5177
Mailing Address - Fax:708-339-3583
Practice Address - Street 1:31 W. 155TH STREET
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426
Practice Address - Country:US
Practice Address - Phone:708-596-5177
Practice Address - Fax:708-339-3583
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.014010363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health