Kord Johnson, | |
10116 E Tarragon Ave, Mesa, AZ 85212-8416 | |
(480) 313-8783 | |
Not Available |
Full Name | Kord Johnson |
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Gender | Male |
Speciality | Nurse Anesthetist, Certified Registered |
Location | 10116 E Tarragon Ave, Mesa, Arizona |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
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1306427380 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
163W00000X | Registered Nurse | 60455959 (Washington) | Secondary |
367500000X | Nurse Anesthetist, Certified Registered | 135172 (Washington) | Primary |
Entity Name | Providence Wa Anesthesia Services, Pc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1669615894 PECOS PAC ID: 9335298884 Enrollment ID: O20090513000135 |
Mailing Address | Practice Location Address |
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Kord Johnson, 10116 E Tarragon Ave, Mesa, AZ 85212-8416 Ph: () - | Kord Johnson, 10116 E Tarragon Ave, Mesa, AZ 85212-8416 Ph: (480) 313-8783 |
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