Individual
LISA R. JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3015 N BALLAS RD, SAINT LOUIS, MO 63131-2329
(314) 996-5000
Mailing address
3015 N BALLAS RD, SAINT LOUIS, MO 63131-2329
(314) 996-5000
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
2024007274
MO
367500000X
Certified Registered Nurse Anesthetist
RN177866
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1164795993
—
GA
Enumeration date
02/09/2012
Last updated
04/16/2024
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