Provider Demographics
NPI:1154645836
Name:JOHNSTON, LOUISE M (MS, RD, LDN)
Entity Type:Individual
Prefix:MS
First Name:LOUISE
Middle Name:M
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 5TH AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-217-4217
Practice Address - Street 1:757 NORLAND AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-4230
Practice Address - Country:US
Practice Address - Phone:717-217-6800
Practice Address - Fax:717-217-6900
Is Sole Proprietor?:No
Enumeration Date:2010-03-24
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN002232133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50093291OtherCAPTIAL BLUE CROSS
PA1007307260041OtherMEDICAID GROUP #
PAP00878810OtherRAILROAD MEDICARE
PA102466919 0001Medicaid
PA2258141OtherUNITED HEALTH CARE (MAMSI)
PA6288633OtherAETNA HMO
PA867633OtherMEDICARE GROUP #
PA9759565OtherAETNA NON HMO
PAJO2504332OtherHIGHMARK BLUE SHIELD
PA867633OtherMEDICARE GROUP #