Individual
BROCK ROBERT JOHANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
6575 HARVEST LN, STANSBURY PARK, UT 84074-9063
(208) 540-1691
Mailing address
6575 HARVEST LN, STANSBURY PARK, UT 84074-9063
(208) 540-1691
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
3361676
ID
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
03/12/2021
Last updated
01/31/2025
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