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General NPI Number Information
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NPI Number | 1619784550
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Entity Type | Individual
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Provider Name | CHAD JOHNSON CRNA
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Gender | Male
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Dates
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Enumeration Date | 12/13/2024
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 11800 ASTORIA BLVD
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City | HOUSTON
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State | TX
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Zip | 77089-6041
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Country | US
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Telephone | 713-400-2990
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Fax |
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Provider Business Mailing Address
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Address Line | 31322 HORSESHOE MEADOW BEND LN
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City | FULSHEAR
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State | TX
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Zip | 77441-2321
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Country | US
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Telephone | 717-448-7684
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 1169093
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License Number State | TX
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