Basic Information
| Provider Information | |||||||||
| NPI: | 1184397374 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSTON | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | DELANEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 108 BAY AVE | ||||||||
| Address2: | |||||||||
| City: | HALESITE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117431208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314875918 | ||||||||
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| Practice Location | |||||||||
| Address1: | 267 GRANT ST | ||||||||
| Address2: | |||||||||
| City: | BRIDGEPORT | ||||||||
| State: | CT | ||||||||
| PostalCode: | 066102805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033843000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2021 | ||||||||
| LastUpdateDate: | 07/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 702782 | NY | N | Nursing Service Providers | Registered Nurse | 163W00000X | 159580 | CT | Y | Nursing Service Providers | Registered Nurse |
No ID Information.