Healthcare Provider Details

I. General information

NPI: 1679409601
Provider Name (Legal Business Name): LIONDRA HARROLD-JOHNSON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LIONDRA HARROLD

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

553 HACKBERRY RIDGE TRCE
BIRMINGHAM AL
35226-2965
US

IV. Provider business mailing address

553 HACKBERRY RIDGE TRCE
BIRMINGHAM AL
35226-2965
US

V. Phone/Fax

Practice location:
  • Phone: 314-593-7434
  • Fax:
Mailing address:
  • Phone: 314-593-7434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-196586
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: