Provider Demographics
NPI:1023648003
Name:JOHNSTON, RHONDA ANNE (MS)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:ANNE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10432 GARDO CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63137-3525
Mailing Address - Country:US
Mailing Address - Phone:314-761-3800
Mailing Address - Fax:
Practice Address - Street 1:10432 GARDO CT
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63137-3525
Practice Address - Country:US
Practice Address - Phone:314-761-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-18
Last Update Date:2020-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1770998486Medicaid