Provider Demographics
NPI:1437322724
Name:JOHNSON, REBECCA ANN (CRNA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 918005
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-8005
Mailing Address - Country:US
Mailing Address - Phone:214-750-6200
Mailing Address - Fax:214-750-6203
Practice Address - Street 1:6901 SNIDER PLZ STE 150
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-5603
Practice Address - Country:US
Practice Address - Phone:214-750-6200
Practice Address - Fax:214-750-6203
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX238807367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant