Provider Demographics
NPI:1750880563
Name:JOHNSTON, MARY JOAN
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:JOAN
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2772 S 39TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-3234
Mailing Address - Country:US
Mailing Address - Phone:402-480-1744
Mailing Address - Fax:402-436-1655
Practice Address - Street 1:2772 S 39TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-3234
Practice Address - Country:US
Practice Address - Phone:402-480-1744
Practice Address - Fax:402-436-1655
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE16990164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse