MEDICARE: LIONDRA HARROLD-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	1-196586	AL

General Provider Information

NPI Number	:	1679409601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIONDRA HARROLD-JOHNSON CRNA

Provider Business Mailing Address
First Line	:	553 HACKBERRY RIDGE TRCE
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35226-2965
Country	:	US
Telephone Number	:	314-593-7434
Fax Number	:

Provider Business Practice Location Address
First Line	:	553 HACKBERRY RIDGE TRCE
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35226-2965
Country	:	US
Telephone Number	:	314-593-7434
Fax Number	:

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

Provider Enumeration Date	:	06/18/2026
Last Update Date	:	06/18/2026

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