Healthcare Provider Details

I. General information

NPI: 1326255449
Provider Name (Legal Business Name): ANDREW JOSEPH JOHNSON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 MONROE ST
PELLA IA
50219-1290
US

IV. Provider business mailing address

405 MONROE ST
PELLA IA
50219-1290
US

V. Phone/Fax

Practice location:
  • Phone: 641-621-2201
  • Fax: 641-620-2050
Mailing address:
  • Phone: 641-621-2201
  • Fax: 641-620-2050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number129967
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberD129967
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: