Individual
MARY ANNE JOHNSON
Active
Individual
MARY ANNE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704120956
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104537338
—
MI
01
—
11802470
CAQH
—
01
—
F36455195
MEDICARE CHMC PTAN
—
01
—
MR120956
BLUE CROSS OF MI
MI
Enumeration date
01/16/2006
Last updated
10/10/2016
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