Provider Demographics
NPI:1821198763
Name:JOHNSTON, ROBIN A (RN,CS,MS,NPP)
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:A
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:RN,CS,MS,NPP
Other - Prefix:MS
Other - First Name:ROBIN
Other - Middle Name:A
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NPP
Mailing Address - Street 1:253 BREWSTER HILL RD
Mailing Address - Street 2:
Mailing Address - City:LAURENS
Mailing Address - State:NY
Mailing Address - Zip Code:13796-1195
Mailing Address - Country:US
Mailing Address - Phone:607-431-9701
Mailing Address - Fax:
Practice Address - Street 1:253 BREWSTER HILL RD
Practice Address - Street 2:
Practice Address - City:LAURENS
Practice Address - State:NY
Practice Address - Zip Code:13796-1195
Practice Address - Country:US
Practice Address - Phone:607-431-9701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400406-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYIA0592Medicare ID - Type UnspecifiedMEDICARE SOLO PROVIDER ID
NYS40230Medicare UPIN