1184696544 NPI number — BARBARA L JOHNSTON NP APN RN MS

Table of content: BARBARA L JOHNSTON NP APN RN MS (NPI 1184696544)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184696544 NPI number — BARBARA L JOHNSTON NP APN RN MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSTON
Provider First Name:
BARBARA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP APN RN MS
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:
1184696544
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
215 W STRATFORD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEORIA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61614-7346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-472-6475
Provider Business Mailing Address Fax Number:
309-673-6914

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2338 N. VAN WINKLE WAY
Provider Second Line Business Practice Location Address:
SUITE 2200
Provider Business Practice Location Address City Name:
PEORIA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-692-6088
Provider Business Practice Location Address Fax Number:
309-692-0502
Provider Enumeration Date:
02/01/2006

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: 363LP0200X , with the licence number:  209005123 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 209005123 . This is a "APN LICENSE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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