Provider Demographics
NPI:1437545613
Name:JOHNSTON, JENNIFER COLLEEN
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:COLLEEN
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37206-2050
Mailing Address - Country:US
Mailing Address - Phone:763-229-7498
Mailing Address - Fax:
Practice Address - Street 1:1812 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37206-2050
Practice Address - Country:US
Practice Address - Phone:763-229-7498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other