Provider Demographics
NPI:1548638448
Name:JOHN, MINNA
Entity type:Individual
Prefix:
First Name:MINNA
Middle Name:
Last Name:JOHN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 E WOODFIELD RD
Mailing Address - Street 2:# 300
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4712
Mailing Address - Country:US
Mailing Address - Phone:184-777-3508
Mailing Address - Fax:
Practice Address - Street 1:802 E WOODFIELD RD
Practice Address - Street 2:# 300
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4712
Practice Address - Country:US
Practice Address - Phone:184-777-3508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.013182363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care