Leslie Renee Johnson, BSN, RN

Individual provider Active NPI Registered Nurse · St. Joseph, IL

NPI 1619908308 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1619908308
Entity type
Individual (NPI type 1)
Primary specialty
Registered Nurse 163W00000X
Practice address
204 N. Main
St. Joseph, IL 61873-8431
Phone
(217) 469-2232
Fax
(217) 469-2381
NPI assigned
Jul 5, 2006
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Bachelor on Science - Nursing, Registered Nurse

State licenses

LicenseStateTypeSpecialty
041-346937ILMDRegistered Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X IL Yes

Addresses

Primary practice location

204 N. Main
St. Joseph, IL 61873-8431

Mailing address

1702 Locust Dr
Saint Joseph, IL 61873-8431
Phone (217) 637-3782

Other providers in St. Joseph, IL

All providers in St. Joseph, IL · Registered Nurse in Illinois

Sources for this page

Verify at the official NPI Registry.