Provider Demographics
NPI:1629427109
Name:JOHNSTON, ELIZABETH DABNEY PEARCE (CRNP, CNM)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DABNEY PEARCE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:CRNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 W REDWOOD ST
Mailing Address - Street 2:STE 500
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-7001
Mailing Address - Country:US
Mailing Address - Phone:667-214-1302
Mailing Address - Fax:
Practice Address - Street 1:419 W REDWOOD ST STE 500
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-7001
Practice Address - Country:US
Practice Address - Phone:667-214-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR201041363LX0001X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD524428500Medicaid