Provider Demographics
NPI:1972702595
Name:JOHNSON, JILL C (DO)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:C
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 13TH AVE N
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-5067
Mailing Address - Country:US
Mailing Address - Phone:563-243-2511
Mailing Address - Fax:563-243-0817
Practice Address - Street 1:915 13TH AVE N
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-5067
Practice Address - Country:US
Practice Address - Phone:563-243-2511
Practice Address - Fax:563-243-0817
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3927207Q00000X
IL036-126332207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine