Provider Demographics
NPI:1003897083
Name:JOHNSON, WILLIAM HAROLD (CRNA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:HAROLD
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:PO BOX 1611
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68702-1611
Mailing Address - Country:US
Mailing Address - Phone:308-382-7744
Mailing Address - Fax:308-382-7744
Practice Address - Street 1:3400 W NORFOLK AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-7701
Practice Address - Country:US
Practice Address - Phone:308-382-7744
Practice Address - Fax:308-382-7744
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE60150367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEP00046371OtherRR MEDICARE
NE38225OtherBCBS OF NE
NE10025009800Medicaid
NE38225OtherBCBS OF NE
NE10025009800Medicaid