MEDICARE: JOEANN 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	91680	CA

General Provider Information

NPI Number	:	1134655616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEANN JOHNSON

Provider Business Mailing Address
First Line	:	1360 S FIGUEROA ST APT 405
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90015-2883
Country	:	US
Telephone Number	:	216-849-2519
Fax Number	:

Provider Business Practice Location Address
First Line	:	1360 S FIGUEROA ST APT 405
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90015-2883
Country	:	US
Telephone Number	:	216-849-2519
Fax Number	:

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

Provider Enumeration Date	:	05/03/2017
Last Update Date	:	05/03/2017

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