Provider Demographics
NPI:1174678346
Name:JOHNSON, VICKI (CPM)
Entity Type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6092 TORCH LITE TRL
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-3424
Mailing Address - Country:US
Mailing Address - Phone:815-885-3370
Mailing Address - Fax:
Practice Address - Street 1:6092 TORCH LITE TRL
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-3424
Practice Address - Country:US
Practice Address - Phone:815-885-3370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife