Provider Demographics
NPI:1114645306
Name:JOHNSTON-MACK, LAURA L (NBC-HWC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:JOHNSTON-MACK
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11607 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:ANDERSON ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98303-8646
Mailing Address - Country:US
Mailing Address - Phone:425-295-1091
Mailing Address - Fax:
Practice Address - Street 1:11607 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:ANDERSON ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98303-8646
Practice Address - Country:US
Practice Address - Phone:425-295-1091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach