Healthcare Provider Details

I. General information

NPI: 1427338979
Provider Name (Legal Business Name): YELENA V JOHNSON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2011
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 AMHERST ST
WINCHESTER VA
22601-2808
US

IV. Provider business mailing address

878 FOX DR
WINCHESTER VA
22603-8613
US

V. Phone/Fax

Practice location:
  • Phone: 540-536-8000
  • Fax: 540-536-7780
Mailing address:
  • Phone: 540-662-8336
  • Fax: 540-662-8593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024179831
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number72851
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: