Basic Information
Provider Information
NPI: 1699776278
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JOHNSTONE-BRADSHAW
FirstName: NANCY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: JOHNSTONE
OtherFirstName: NANCY
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: CRNA
OtherLastNameType: 1
Mailing Information
Address1: 100 ROUTE 59
Address2: SUITE 105
City: SUFFERN
State: NY
PostalCode: 109014927
CountryCode: US
TelephoneNumber: 8453575775
FaxNumber: 8453575777
Practice Location
Address1: 127 S BROADWAY
Address2: SAINT JOSEPH'S MEDICAL CENTER
City: YONKERS
State: NY
PostalCode: 107014006
CountryCode: US
TelephoneNumber: 9143787000
FaxNumber: 8453575777
Other Information
ProviderEnumerationDate: 08/09/2005
LastUpdateDate: 06/25/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000X385672NYY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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