Provider Demographics
NPI:1881789949
Name:JOHNSON, LORI A (FNP)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:LORI
Other - Middle Name:A
Other - Last Name:COURSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1106 N MERCHANT ST
Mailing Address - Street 2:P.O. BOX 665
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-2128
Mailing Address - Country:US
Mailing Address - Phone:217-342-7000
Mailing Address - Fax:217-342-7002
Practice Address - Street 1:1106 N MERCHANT ST
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-2128
Practice Address - Country:US
Practice Address - Phone:217-342-7000
Practice Address - Fax:217-342-7002
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-245291163W00000X
IL209-000472363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse