Provider Demographics
NPI:1013083732
Name:JOHNSON, CHRISTINE M (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:CHRISTINE
Other - Middle Name:M
Other - Last Name:GUTHLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1298 EISENHOWER RD
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-5532
Mailing Address - Country:US
Mailing Address - Phone:913-727-5600
Mailing Address - Fax:816-727-5602
Practice Address - Street 1:1298 EISENHOWER RD
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-5532
Practice Address - Country:US
Practice Address - Phone:913-727-5600
Practice Address - Fax:816-727-5602
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO095632367500000X
KS55414367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS4065138Medicare ID - Type Unspecified
R30257Medicare UPIN
MO4065138Medicare ID - Type Unspecified