Provider Demographics
NPI:1558475426
Name:JOHNSTON, REBECCA L (NP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-5507
Mailing Address - Country:US
Mailing Address - Phone:978-534-8701
Mailing Address - Fax:978-534-8705
Practice Address - Street 1:87 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453
Practice Address - Country:US
Practice Address - Phone:978-534-8701
Practice Address - Fax:978-534-8705
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA297249363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS95815Medicare UPIN