Healthcare Provider Details

I. General information

NPI: 1093744419
Provider Name (Legal Business Name): ROLINDA JOHNSON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18448 TORRENCE CHAPEL ESTATES CIR
CORNELIUS NC
28031-6853
US

IV. Provider business mailing address

18448 TORRENCE CHAPEL ESTATES CIR
CORNELIUS NC
28031-6853
US

V. Phone/Fax

Practice location:
  • Phone: 517-214-5016
  • Fax: 704-987-2436
Mailing address:
  • Phone: 517-214-5016
  • Fax: 704-987-2436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number180361
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: