Provider Demographics
NPI:1487355186
Name:JOHNSON, ALKANSAS LYNN (PHLEBOTOMIST)
Entity type:Individual
Prefix:
First Name:ALKANSAS
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17144 GREENBAY AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-1332
Mailing Address - Country:US
Mailing Address - Phone:630-460-8087
Mailing Address - Fax:
Practice Address - Street 1:17144 GREENBAY AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-1332
Practice Address - Country:US
Practice Address - Phone:630-460-8087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILS6B7D4F6156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist