Individual
MR. BRADLEY P JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
196 NORTH STREET, GENEVA, NY 14456
(315) 787-4533
Mailing address
202 TAUGHANNOCK BLVD., PO BOX 366, ITHACA, NY 14851
(607) 277-3257
(607) 277-4056
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
532646
NY
Other
Enumeration date
04/19/2006
Last updated
01/11/2010
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