Provider Demographics
NPI:1164432845
Name:JOHNSTON, RHONDA L (PHD, CFNP, CANP, CNS)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:L
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:PHD, CFNP, CANP, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6736 S QUANTOCK WAY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-2487
Mailing Address - Country:US
Mailing Address - Phone:303-324-1370
Mailing Address - Fax:
Practice Address - Street 1:4100 E MISSISSIPPI AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CO
Practice Address - Zip Code:80246-3048
Practice Address - Country:US
Practice Address - Phone:303-372-7808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO68150363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07681505Medicaid
CO805450Medicare UPIN
CO300390Medicare Oscar/Certification
CO300390Medicare UPIN
CO805450Medicare PIN
CO300390Medicare PIN
CO805450Medicare Oscar/Certification