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NPI Code Detail

MEDICARE: MARY ELIZABETH LUHR JOHNSON CRNA

MEDICARE: MARY ELIZABETH LUHR JOHNSON CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist343884NY

General Provider Information

NPI Number : 1194925339
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY ELIZABETH LUHR JOHNSON CRNA
Provider Business Mailing Address
First Line : 8121 W CANAL RD
Second Line :
City : BROCKPORT
State : NY
Zip : 14420-2103
Country : US
Telephone Number : 585-395-1343
Fax Number : 585-733-6501
Provider Business Practice Location Address
First Line : 200 OHIO ST
Second Line :
City : MEDINA
State : NY
Zip : 14103-1063
Country : US
Telephone Number : 585-798-8300
Fax Number : 585-798-8439
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2007
Last Update Date : 07/24/2007

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