Provider Demographics
NPI:1558136390
Name:MUHAMMAD JOHNSON, AMANI (PA)
Entity Type:Individual
Prefix:
First Name:AMANI
Middle Name:
Last Name:MUHAMMAD JOHNSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AMANI
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:529 W 127TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-7151
Mailing Address - Country:US
Mailing Address - Phone:773-799-1655
Mailing Address - Fax:
Practice Address - Street 1:529 W 127TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-7151
Practice Address - Country:US
Practice Address - Phone:773-799-1655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-21
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant