Individual
JEREMY THOMAS JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1253 NW CANAL BLVD, REDMOND, OR 97756-1334
(541) 548-8131
Mailing address
PO BOX 3330, SALT LAKE CITY, UT 84110-3330
(888) 333-1095
(770) 701-6674
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
196302
NC
367500000X
Certified Registered Nurse Anesthetist
Primary
201393463CRNA
OR
Other
Enumeration date
09/11/2007
Last updated
09/07/2022
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