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Individual

RYAN CHARLES JOHNSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
6839 S CANTON AVE, TULSA, OK 74136-3402
(918) 494-0612
Mailing address
7509 E 77TH CT, TULSA, OK 74133-3524
(918) 521-2081

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R0100733
OK
367500000X
Certified Registered Nurse Anesthetist
Primary
100733
OK

Other

Enumeration date
11/27/2017
Last updated
01/30/2020
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