Healthcare Provider Details

I. General information

NPI: 1841639283
Provider Name (Legal Business Name): DONALD E. JOHNSON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2013
Last Update Date: 05/13/2020
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3719 DAUPHIN ST
MOBILE AL
36608-1753
US

IV. Provider business mailing address

1613 HARRISON PKWY SUITE #200
SUNRISE FL
33323-2896
US

V. Phone/Fax

Practice location:
  • Phone: 251-344-9630
  • Fax:
Mailing address:
  • Phone: 954-838-2371
  • Fax: 954-851-1746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR886744
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-106784
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: