Healthcare Provider Details

I. General information

NPI: 1609969583
Provider Name (Legal Business Name): DAVID S JOHNSON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 CLIFF AVE SUITE 101 EYE SURGERY CENTER THE CLIFFS
INDEPENDENCE MO
64055
US

IV. Provider business mailing address

4801 CLIFF AVE SUITE 100 ADMIN
INDEPENDENCE MO
64055
US

V. Phone/Fax

Practice location:
  • Phone: 816-478-4400
  • Fax: 816-478-8240
Mailing address:
  • Phone: 816-478-1230
  • Fax: 816-350-4585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number105291
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1492144101
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: