Provider Demographics
NPI:1689193831
Name:JOHNSTON, GIDGET MICHELLE (CST,CSFA)
Entity Type:Individual
Prefix:
First Name:GIDGET
Middle Name:MICHELLE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:CST,CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1136
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77588-1136
Mailing Address - Country:US
Mailing Address - Phone:281-948-1520
Mailing Address - Fax:
Practice Address - Street 1:16100 SOUTH FWY
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-1895
Practice Address - Country:US
Practice Address - Phone:713-413-5770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-19
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX172773246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant