Provider Demographics
NPI:1639366131
Name:JOHNSTON, ROBERTA R (LPN)
Entity Type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:R
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3197 FOOTVILLE RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:DORSET
Mailing Address - State:OH
Mailing Address - Zip Code:44032-9605
Mailing Address - Country:US
Mailing Address - Phone:440-858-2333
Mailing Address - Fax:
Practice Address - Street 1:3197 FOOTVILLE RICHMOND RD
Practice Address - Street 2:
Practice Address - City:DORSET
Practice Address - State:OH
Practice Address - Zip Code:44032-9605
Practice Address - Country:US
Practice Address - Phone:440-858-2333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN113643164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse