Gary R Johanson, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

RNA-28A Issued in ID

Practice address

1950 E Clark St
Suite G
Pocatello, ID 83201-3314

Phone

(208) 232-7760

Fax

(208) 232-1950

NPI assigned

May 11, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318982400000",
    "number": "1700836418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4107",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832054107",
            "telephone_number": "208-232-7760",
            "fax_number": "208-232-1950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1950 E CLARK ST",
            "address_2": "SUITE G",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832013314",
            "telephone_number": "208-232-7760",
            "fax_number": "208-232-1950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHANSON",
        "first_name": "GARY",
        "middle_name": "R",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-11",
        "last_updated": "2011-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "ID",
            "license": "N15687",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "ID",
            "license": "RNA-28A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004371700",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristen Jex, LPC
• Jared Jockumsen, LSW
• Joe'S Shuttle Service
• Arpun Kaur Johal, DDS
• Nikki K Johansen
• John Fornarotto PLLC
• John L Christensen PHD PC
• Johnson & Snow Dental, PA
• Johnson Family Chiropractic & Sports Clinic PLLC
• Alyssa Lenae Johnson

• Certified Registered Nurse Anesthetist in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Certified Registered Nurse Anesthetist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.