Provider Demographics
NPI:1447576541
Name:JOHNSTONE, SYDNEY KATHERINE (PA-C)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:KATHERINE
Last Name:JOHNSTONE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 NW SAMARITAN DR STE 201
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-4714
Mailing Address - Country:US
Mailing Address - Phone:541-768-6300
Mailing Address - Fax:541-768-6301
Practice Address - Street 1:3620 NW SAMARITAN DR STE 201
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-4714
Practice Address - Country:US
Practice Address - Phone:541-768-6300
Practice Address - Fax:541-768-6301
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60120252363A00000X
ORPA155839363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant