MEDICARE: MS. JOHANNA SCOTT 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	106334	MO

General Provider Information

NPI Number	:	1477508653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JOHANNA SCOTT CRNA

Provider Business Mailing Address
First Line	:	123 FOXTROT DRIVE
Second Line	:
City	:	GALENA
State	:	MO
Zip	:	65656
Country	:	US
Telephone Number	:	417-464-8457
Fax Number	:

Provider Business Practice Location Address
First Line	:	123 FOXTROT DRIVE
Second Line	:
City	:	GALENA
State	:	MO
Zip	:	65656
Country	:	US
Telephone Number	:	417-464-8457
Fax Number	:

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

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	07/08/2007

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