Healthcare Provider Details

I. General information

NPI: 1538497565
Provider Name (Legal Business Name): CHRISTINA ANN JOHNSON CRNA, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2009
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 W 95TH ST
OAK LAWN IL
60453-2654
US

IV. Provider business mailing address

2312 HICKORY DR
DYER IN
46311-1851
US

V. Phone/Fax

Practice location:
  • Phone: 708-684-5745
  • Fax:
Mailing address:
  • Phone: 219-864-8803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209.007862
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: