1144515057 NPI number — MRS. RACHEL P STEWART- JOHNSON CRNA

Table of content: MRS. RACHEL P STEWART- JOHNSON CRNA (NPI 1144515057)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144515057 NPI number — MRS. RACHEL P STEWART- JOHNSON CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEWART- JOHNSON
Provider First Name:
RACHEL
Provider Middle Name:
P
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144515057
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
196 THOMAS JOHNSON DR
Provider Second Line Business Mailing Address:
SUITE 215
Provider Business Mailing Address City Name:
FREDERICK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21702-4397
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-668-9988
Provider Business Mailing Address Fax Number:
301-668-9977

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 GARRETT AVE
Provider Second Line Business Practice Location Address:
POST OFFICE BOX 1070
Provider Business Practice Location Address City Name:
LA PLATA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20646-5960
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-609-4285
Provider Business Practice Location Address Fax Number:
301-934-6958
Provider Enumeration Date:
06/20/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  R133908 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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