MEDICARE: DANIEL SCOTT JOHNSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	78095	ID
2	367500000X	Certified Registered Nurse Anesthetist	209.035607	IL

General Provider Information

NPI Number	:	1013774868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL SCOTT JOHNSON

Provider Business Mailing Address
First Line	:	2024 BLUE SKY LN
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83301-5558
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 POLE LINE RD W
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83301-5810
Country	:	US
Telephone Number	:	208-734-7362
Fax Number	:	208-814-0948

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2024
Last Update Date	:	05/15/2026

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Directions to “ DANIEL SCOTT JOHNSON ” Practice Location

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