1366410102 NPI number — LAURA D JOHNSTON LISW

Table of content: LAURA D JOHNSTON LISW (NPI 1366410102)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366410102 NPI number — LAURA D JOHNSTON LISW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSTON
Provider First Name:
LAURA
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LISW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366410102
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
177 LOWERY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW CONCORD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43762-9795
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-826-4376
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 JOHN GLENN HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMBRIDGE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43725-9028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-454-9766
Provider Business Practice Location Address Fax Number:
740-588-6452
Provider Enumeration Date:
03/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  I8573 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000340445 . This is a "ANTHEM PIN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 352005 . This is a "TRICARE/MHN PIN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 7372590 . This is a "AETNA PIN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: Y08573 . This is a "THE HEALTH PLAN PIN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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