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NPI Code Detail

MEDICARE: MS. JENNIFER LYNN JOHNSON CRNA

MEDICARE: MS. JENNIFER LYNN JOHNSON CRNA
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
1367500000XCertified Registered Nurse Anesthetist2002014117MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1431560263069OTHERTRICARE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1730186834
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JENNIFER LYNN JOHNSON CRNA
Provider Business Mailing Address
First Line : 99 EAST RIVER DRIVE
Second Line : 5TH FLOOR
City : EAST HATFORD
State : CT
Zip : 06108-7301
Country : US
Telephone Number : 860-282-0833
Fax Number :
Provider Business Practice Location Address
First Line : 80 SEYMOUR ST
Second Line :
City : HARTFORD
State : CT
Zip : 06106-3300
Country : US
Telephone Number : 860-545-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2005
Last Update Date : 12/01/2023

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