Jerisa Johnson D.O.

NPI 1679760045 - Family Medicine - 207Q00000X

NPI Details
NPI 1679760045
Gender Female
Enumeration Date 10/01/2007
Last Updated 01/02/2012
Entity Type Individual
Active Over 9 years ago
Practice Location
1649 E 50TH ST APT 7E
CHICAGO IL, 60615-3131, US
Phone (773) 816-1117
Fax
Business Location
1649 E 50TH ST APT 7E
CHICAGO IL, 60615-3131, US
Phone (773) 816-1117
Fax
Toxanomy
Taxonomy Code 207Q00000X
License State Illinois
License Number 125049751
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According to our database, Dr. Jerisa Johnson D.O. NPI is 1679760045, taxonomy code is 207Q00000X and license number is 125049751, license state is located at Illinois. Jerisa Johnson D.O. physically located at 1649 E 50th St Apt 7e, Chicago IL, 60615-3131. NPI Number Jerisa Johnson D.O. has the Individual type.

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1679760045 NPI number is provided on an as is basis without warranty of any kind. 1679760045 is maintained by the National Plan & Provider Enumeration System. The contents of Jerisa Johnson D.O. are for informational purposes only.