Healthcare Provider Details

I. General information

NPI: 1215909577
Provider Name (Legal Business Name): MICHAEL W JOHNSTON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

8310 N CAPITAL OF TEXAS HWY SUITE 350
AUSTIN TX
78731-1011
US

IV. Provider business mailing address

12421 GUN METAL DR
AUSTIN TX
78739-4825
US

V. Phone/Fax

Practice location:
  • Phone: 512-342-2382
  • Fax: 512-342-2878
Mailing address:
  • Phone: 512-292-3243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR158787-8
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: