Provider Demographics
NPI:1609021344
Name:JOHNSTON, LYNN J (FNP, PNP-C)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:J
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:FNP, PNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 CHANATE RD
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-1710
Mailing Address - Country:US
Mailing Address - Phone:707-565-4820
Mailing Address - Fax:
Practice Address - Street 1:5011 RICK DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-2734
Practice Address - Country:US
Practice Address - Phone:707-538-4937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA246295363LF0000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics