Brock Robert Johanson, CRNA
Nurse Anesthetist, Certified Registered in Stansbury Park, UT. Individual provider (NPI-1).
NPI number1982289864
StatusActive
Last updated in NPPESJan 31, 2025
Details
- NPI
- 1982289864
- Entity type
- Individual (NPI-1)
- Name
- Brock Robert Johanson
- Credential
- CRNA
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Mar 12, 2021
- Certification date
- Jan 31, 2025
- Last updated
- Jan 31, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | 3361676 | ID | Yes |
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – |
Practice location
6575 Harvest LnStansbury Park, UT 84074-9063
Phone 208-540-1691
Mailing address
6575 Harvest LnStansbury Park, UT 84074-9063
Phone 208-540-1691
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