Provider Demographics
NPI:1639647449
Name:JOHNSTON, VANESSA (FNP)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2852 WILLAMETTE ST STE 400
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-8200
Mailing Address - Country:US
Mailing Address - Phone:541-246-3400
Mailing Address - Fax:541-246-3421
Practice Address - Street 1:2401 RIVER RD STE 101
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404
Practice Address - Country:US
Practice Address - Phone:541-344-8469
Practice Address - Fax:541-687-8631
Is Sole Proprietor?:No
Enumeration Date:2018-11-09
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201810088NP-PP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner