Individual
KEVIN BRADLEY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
35345 WOODLAND LN, ASTORIA, OR 97103-8351
(503) 325-4548
Mailing address
35345 WOODLAND LN, ASTORIA, OR 97103-8351
(503) 325-4548
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
079043924CRNA
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
196407
—
OR
05
—
9609439
—
WA
Enumeration date
11/10/2006
Last updated
07/09/2007
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