Provider Demographics
NPI:1083041214
Name:JOHNSTONE, CHRISTOPHER WAYNE
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:WAYNE
Last Name:JOHNSTONE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 S 10TH ST
Mailing Address - Street 2:BLSB, ROOM 1050
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5541
Mailing Address - Country:US
Mailing Address - Phone:188-895-5121
Mailing Address - Fax:
Practice Address - Street 1:233 S 10TH ST
Practice Address - Street 2:BLSB, ROOM 1050
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5541
Practice Address - Country:US
Practice Address - Phone:188-895-5121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012926363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care