Provider Demographics
NPI:1619908308
Name:JOHNSON, LESLIE RENEE (BSN, RN)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:RENEE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 LOCUST DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:IL
Mailing Address - Zip Code:61873-8431
Mailing Address - Country:US
Mailing Address - Phone:217-637-3782
Mailing Address - Fax:
Practice Address - Street 1:204 N. MAIN
Practice Address - Street 2:
Practice Address - City:ST. JOSEPH
Practice Address - State:IL
Practice Address - Zip Code:61873-8431
Practice Address - Country:US
Practice Address - Phone:217-469-2232
Practice Address - Fax:217-469-2381
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse