Provider Demographics
NPI:1437936549
Name:JOHNSON, STEPHANIE M (APRN)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:M
Other - Last Name:ROLANDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1285 FRANCISCAN DR
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62056-1778
Mailing Address - Country:US
Mailing Address - Phone:217-324-6127
Mailing Address - Fax:217-324-5959
Practice Address - Street 1:1285 FRANCISCAN DR
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:IL
Practice Address - Zip Code:62056-1778
Practice Address - Country:US
Practice Address - Phone:217-324-6127
Practice Address - Fax:217-324-5959
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.028197363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily