Provider Demographics
NPI:1922096601
Name:JOHNSON, LUANNE DEE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:LUANNE
Middle Name:DEE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:LUANNE
Other - Middle Name:D
Other - Last Name:PFEIFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNPC
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:IL
Mailing Address - Zip Code:62321-0160
Mailing Address - Country:US
Mailing Address - Phone:217-357-2173
Mailing Address - Fax:217-357-6564
Practice Address - Street 1:204 CENTER ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:IL
Practice Address - Zip Code:62311-1228
Practice Address - Country:US
Practice Address - Phone:217-392-2108
Practice Address - Fax:217-392-2110
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA060889363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209008589Medicaid
ILF400111561Medicare PIN