Provider Demographics
NPI:1891281432
Name:JOHNSTON, ALYSSA VIRGINIA (NP)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:VIRGINIA
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:VIRGINIA
Other - Last Name:MAKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1814 CIRBY WAY APT B
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-5564
Mailing Address - Country:US
Mailing Address - Phone:770-876-9602
Mailing Address - Fax:
Practice Address - Street 1:1814 CIRBY WAY APT B
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-5564
Practice Address - Country:US
Practice Address - Phone:770-876-9602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-06
Last Update Date:2022-04-11
Deactivation Date:2019-11-21
Deactivation Code:
Reactivation Date:2019-11-27
Provider Licenses
StateLicense IDTaxonomies
CA95013336207QA0505X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine