1558433060 NPI number — MRS. NICOLE BARBARA JOHNSTON D.C.

Table of content: MRS. NICOLE BARBARA JOHNSTON D.C. (NPI 1558433060)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558433060 NPI number — MRS. NICOLE BARBARA JOHNSTON D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSTON
Provider First Name:
NICOLE
Provider Middle Name:
BARBARA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JENSEN
Provider Other First Name:
NICOLE
Provider Other Middle Name:
BARBARA
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1558433060
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 CATTELL ST FL 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EASTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18042-7606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-258-0252
Provider Business Mailing Address Fax Number:
610-258-0663

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 CATTELL ST FL 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EASTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18042-7606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-258-0252
Provider Business Practice Location Address Fax Number:
610-258-0663
Provider Enumeration Date:
11/14/2006

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: 111N00000X , with the licence number:  DC009700 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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