Healthcare Provider Details

I. General information

NPI: 1316360738
Provider Name (Legal Business Name): PATRICK C JOHNSON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2014
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 ALUMNI DR
EXETER NH
03833-2128
US

IV. Provider business mailing address

7 HOLLAND WAY FL 1
EXETER NH
03833-2997
US

V. Phone/Fax

Practice location:
  • Phone: 603-580-6624
  • Fax: 603-580-6620
Mailing address:
  • Phone: 603-777-1096
  • Fax: 603-580-7210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRNA193016
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number068985-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: