Basic Information
| Provider Information | |||||||||
| NPI: | 1598116980 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSTON | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | DOMENICA | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | FNP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | JOHNSTON | ||||||||
| OtherFirstName: | CHRISTINE | ||||||||
| OtherMiddleName: | DOMENICA | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 9 DARTMOUTH LN | ||||||||
| Address2: | |||||||||
| City: | RICHBORO | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189541262 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154996413 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1627 CHEW ST | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181023648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109693390 | ||||||||
| FaxNumber: | 6109693393 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2016 | ||||||||
| LastUpdateDate: | 07/05/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 07/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | SP016172 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.