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General NPI Number Information
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NPI Number | 1093860868
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Entity Type | Individual
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Provider Name | LESA RENEE JOHNSON CRNA
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Gender | Female
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 04/23/2019
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Provider Practice Location Address
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Address Line | 101 HOSPITAL CIR
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City | LUVERNE
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State | AL
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Zip | 36049-7329
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Country | US
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Telephone | 334-335-1172
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Fax |
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Provider Business Mailing Address
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Address Line | 567 W 6TH ST
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City | LUVERNE
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State | AL
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Zip | 36049-1649
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Country | US
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Telephone | 334-335-5334
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 077313
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 1-077282
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License Number State | AL
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