Individual
LARRY W JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
400 E 3RD ST, DULUTH, MN 55805-1951
(218) 786-4150
Mailing address
400 E 3RD ST, DULUTH, MN 55805-1951
(218) 786-4150
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R113631-3
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
509162400
—
MN
Enumeration date
06/06/2006
Last updated
06/27/2011
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