MEDICARE: WAYNE ANDREW JOHNSTON 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	95055	CO

General Provider Information

NPI Number	:	1912900127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WAYNE ANDREW JOHNSTON CRNA

Provider Business Mailing Address
First Line	:	PO BOX 3279
Second Line	:
City	:	DURANGO
State	:	CO
Zip	:	81302-3279
Country	:	US
Telephone Number	:	970-247-9606
Fax Number	:

Provider Business Practice Location Address
First Line	:	28 HUNTER CT
Second Line	:
City	:	DURANGO
State	:	CO
Zip	:	81301-7252
Country	:	US
Telephone Number	:	970-247-9606
Fax Number	:

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	07/08/2007

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