MEDICARE: RYAN JOHNSON

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	4704327275	MI
2	163W00000X	Registered Nurse	4704327275	MI

General Provider Information

NPI Number	:	1962122986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN JOHNSON

Provider Business Mailing Address
First Line	:	1778 N HUGHES RD
Second Line	:
City	:	HOWELL
State	:	MI
Zip	:	48843-9174
Country	:	US
Telephone Number	:	517-294-5788
Fax Number	:

Provider Business Practice Location Address
First Line	:	412 HIGH ST APT 3
Second Line	:
City	:	MARQUETTE
State	:	MI
Zip	:	49855-3876
Country	:	US
Telephone Number	:	517-294-5788
Fax Number	:

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

Provider Enumeration Date	:	08/30/2022
Last Update Date	:	09/23/2025

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Directions to “ RYAN JOHNSON ” Practice Location

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