Provider Demographics
NPI:1093860868
Name:JOHNSON, LESA RENEE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:LESA
Middle Name:RENEE
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 1:567 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LUVERNE
Mailing Address - State:AL
Mailing Address - Zip Code:36049-1649
Mailing Address - Country:US
Mailing Address - Phone:334-335-5334
Mailing Address - Fax:
Practice Address - Street 1:101 HOSPITAL CIR
Practice Address - Street 2:
Practice Address - City:LUVERNE
Practice Address - State:AL
Practice Address - Zip Code:36049-7329
Practice Address - Country:US
Practice Address - Phone:334-335-1172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL077313163W00000X
AL1-077282367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse