Provider Demographics
NPI:1629128673
Name:JOHNSTON, DIANE MARIE (RN)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
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 1:6661 NOFFKE DRIVE
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316
Mailing Address - Country:US
Mailing Address - Phone:616-828-7740
Mailing Address - Fax:
Practice Address - Street 1:1256 WALKER AVE
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:MI
Practice Address - Zip Code:40504
Practice Address - Country:US
Practice Address - Phone:616-235-2910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704127286163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health