Provider Demographics
NPI:1497411664
Name:JOHNSTON, PATRICIA DAWN
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:DAWN
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 1:8940 W OLIVE AVE UNIT 141
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-7003
Mailing Address - Country:US
Mailing Address - Phone:623-200-9287
Mailing Address - Fax:
Practice Address - Street 1:8940 W OLIVE AVE UNIT 141
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-7003
Practice Address - Country:US
Practice Address - Phone:623-200-9287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant