Basic Information
| Provider Information | |||||||||
| NPI: | 1154645836 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSTON | ||||||||
| FirstName: | LOUISE | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M.S., R.D., LDN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 785 5TH AVE | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172639555 | ||||||||
| FaxNumber: | 7172174217 | ||||||||
| Practice Location | |||||||||
| Address1: | 757 NORLAND AVE | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172176800 | ||||||||
| FaxNumber: | 7172176900 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2010 | ||||||||
| LastUpdateDate: | 02/18/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | DN002232 | PA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
ID Information
| ID | Type | State | Issuer | Description | 50093291 | 01 | PA | CAPTIAL BLUE CROSS | OTHER | 1007307260041 | 01 | PA | MEDICAID GROUP # | OTHER | P00878810 | 01 | PA | RAILROAD MEDICARE | OTHER | 102466919 0001 | 05 | PA | MEDICAID | 2258141 | 01 | PA | UNITED HEALTH CARE (MAMSI) | OTHER | 6288633 | 01 | PA | AETNA HMO | OTHER | 867633 | 01 | PA | MEDICARE GROUP # | OTHER | 9759565 | 01 | PA | AETNA NON HMO | OTHER | JO2504332 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER |