Provider Demographics
NPI:1124273354
Name:JOHNSON, MURRAY (CRNA)
Entity type:Individual
Prefix:
First Name:MURRAY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 CENTENNIAL DR.
Mailing Address - Street 2:
Mailing Address - City:CHADRON
Mailing Address - State:NE
Mailing Address - Zip Code:69337-9400
Mailing Address - Country:US
Mailing Address - Phone:308-432-8176
Mailing Address - Fax:308-432-2737
Practice Address - Street 1:825 CENTENNIAL DR.
Practice Address - Street 2:
Practice Address - City:CHADRON
Practice Address - State:NE
Practice Address - Zip Code:69337-9400
Practice Address - Country:US
Practice Address - Phone:308-432-8176
Practice Address - Fax:308-432-2737
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE57237367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE08596OtherBCBS CRNA