Provider Demographics
NPI:1609371913
Name:JOHNSTON, BRENDA ANN (BRANDI)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:ANN
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:BRANDI
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:
Other - Last Name:LOZADA JOHNSTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCN
Mailing Address - Street 1:3806 YELLOWSTONE DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-9064
Mailing Address - Country:US
Mailing Address - Phone:575-405-4142
Mailing Address - Fax:
Practice Address - Street 1:3806 YELLOWSTONE DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-9064
Practice Address - Country:US
Practice Address - Phone:575-405-4142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
No246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
No174H00000XOther Service ProvidersHealth Educator
No2472E0500XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherEEG