MEDICARE: COREY DEAN 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
1	367500000X	Certified Registered Nurse Anesthetist	AP60160350	WA

General Provider Information

NPI Number	:	1447235353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COREY DEAN JOHNSON CRNA

Provider Business Mailing Address
First Line	:	PO BOX 487
Second Line	:
City	:	PULLMAN
State	:	WA
Zip	:	99163-0487
Country	:	US
Telephone Number	:	509-332-4051
Fax Number	:	509-332-4051

Provider Business Practice Location Address
First Line	:	835 SE BISHOP BLVD
Second Line	:
City	:	PULLMAN
State	:	WA
Zip	:	99163-5512
Country	:	US
Telephone Number	:	509-332-4051
Fax Number	:	509-332-4051

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	07/10/2025

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