Johanson, Gary R

Johanson, Gary R is an individual health care provider with primary practice located at 1950 E Clark St Suite G, Pocatello ID 83201-3314. He recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Registered Nurse, Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered. Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered is his primary health care specialty. Johanson, Gary R can be contacted via phone (208) 232-7760.

Contact Information

Primary practice address
1950 E Clark St Suite G Pocatello ID 83201-3314
Phone: (208) 232-7760
Fax: (208) 232-1950
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Registered Nurse 163W00000X N15687 Idaho
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X RNA-28A Idaho

Profile Details

NPI number 1700836418
LBN Legal business name Johanson, Gary R
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date May 11th, 2006
Last updated Oct 19th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1700836418 NPPES
Idaho MEDICAID 004371700

Popular Providers