Provider Demographics
NPI:1497428767
Name:JOHNSTON, SARA SUZANNE (RN)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:SUZANNE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 SAINT CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-4644
Mailing Address - Country:US
Mailing Address - Phone:605-430-4316
Mailing Address - Fax:
Practice Address - Street 1:3625 5TH ST STE 100
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-6002
Practice Address - Country:US
Practice Address - Phone:605-718-1095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-31
Last Update Date:2021-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR045647163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse