1841424801 NPI number — MS. MARY LYNN JOHNSTON APRN

Table of content: MS. MARY LYNN JOHNSTON APRN (NPI 1841424801)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841424801 NPI number — MS. MARY LYNN JOHNSTON APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSTON
Provider First Name:
MARY
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
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:
1841424801
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 GEORGE ST
Provider Second Line Business Mailing Address:
6TH FLOOR
Provider Business Mailing Address City Name:
NEW HAVEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06511-6624
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-785-4216
Provider Business Mailing Address Fax Number:
203-737-6014

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 HOWARD AVE
Provider Second Line Business Practice Location Address:
YPB 4TH FLOOR
Provider Business Practice Location Address City Name:
NEW HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06519-1369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-785-4191
Provider Business Practice Location Address Fax Number:
203-737-6014
Provider Enumeration Date:
05/06/2009

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: 363LA2200X , with the licence number:  002311 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 008003990 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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