Provider Demographics
NPI:1831076074
Name:JOHNSEN, PATRICIA (RN)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:JOHNSEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17100 DIXIE HWY STE D
Mailing Address - Street 2:
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-1485
Mailing Address - Country:US
Mailing Address - Phone:985-705-3263
Mailing Address - Fax:
Practice Address - Street 1:17100 DIXIE HWY STE D
Practice Address - Street 2:
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-1485
Practice Address - Country:US
Practice Address - Phone:985-705-3263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041308670163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)