Individual
GLADE WARREN JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA, BSN
Contact information
Practice address
13677 W MCDOWELL RD, GOODYEAR, AZ 85395-2635
(623) 882-1500
Mailing address
21263 W SYCAMORE DR, BUCKEYE, AZ 85396-7898
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
10836809-3102
UT
367500000X
Certified Registered Nurse Anesthetist
Primary
297873
AZ
Other
Enumeration date
09/15/2023
Last updated
09/20/2023
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