Individual
MR. EDWARD G. JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1 GUTHRIE SQ, SAYRE, PA 18840-1625
(570) 888-5858
Mailing address
1 GUTHRIE SQ, SAYRE, PA 18840-1625
(570) 888-5858
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN216453L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017141250001
—
PA
01
—
430066778
RR MEDICARE PIN
PA
01
—
CC9269
RR MEDICARE GROUP
PA
01
—
GU039832
MEDICARE GROUP
PA
Enumeration date
03/23/2006
Last updated
08/02/2011
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