Individual
TAWNA LYNN JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
401 MATTHEW ST, MARIETTA, OH 45750-1635
(740) 376-1994
(740) 376-1940
Mailing address
PO BOX 449, MARIETTA, OH 45750-0449
(740) 374-4500
(740) 374-5887
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
3670A
KY
367500000X
Certified Registered Nurse Anesthetist
Primary
COA.06152-NA
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000000349540
ANTHEM BLUE CROSS BLUE SHIELD
KY
05
—
0069124000
—
WV
05
—
2515237
—
OH
05
—
74008715
—
KY
Enumeration date
03/02/2006
Last updated
07/08/2015
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