Johnson, Mary Alice

Johnson, Mary Alice is an individual health care provider with primary practice located at 1726 Shawano Ave , Green Bay WI 54303-3216. She 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 her primary health care specialty. Johnson, Mary Alice can be contacted via phone (920) 498-4200.

Contact Information

Primary practice address
1726 Shawano Ave Green Bay WI 54303-3216
Phone: (920) 498-4200
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Registered Nurse 163W00000X 66618-30 Wisconsin
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 033282 Wisconsin

Profile Details

NPI number 1417085705
LBN Legal business name Johnson, Mary Alice
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 1st, 2007
Last updated Jul 21st, 2010 - about 15 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1417085705 NPPES
Wisconsin MEDICAID 43316600

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