MEDICARE: CAPRICE 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
1	367500000X	Certified Registered Nurse Anesthetist	RN305298L	PA
2	367500000X	Certified Registered Nurse Anesthetist	40419	WV

General Provider Information

NPI Number	:	1912908708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAPRICE JOHNSON CRNA

Provider Business Mailing Address
First Line	:	21 LAFOLLETTE DR
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26508-8005
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 LAFOLLETTE DR
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26508-8005
Country	:	US
Telephone Number	:	724-430-5803
Fax Number	:

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

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	10/03/2013

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Directions to “ CAPRICE JOHNSON CRNA” Practice Location

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