Provider Demographics
NPI:1568572089
Name:JOHNSTON, VALERIE S (APRN)
Entity Type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:S
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 BISHOP DR
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-6500
Mailing Address - Country:US
Mailing Address - Phone:508-872-6971
Mailing Address - Fax:
Practice Address - Street 1:14 PORTER ST
Practice Address - Street 2:
Practice Address - City:EAST BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-2116
Practice Address - Country:US
Practice Address - Phone:617-569-3189
Practice Address - Fax:617-569-7890
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA104051363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS53772Medicare UPIN
MAJO NS 0038Medicare ID - Type Unspecified