Provider Demographics
NPI:1922060359
Name:JOHNSTON, DAVID P (CRNA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:P
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1881 THREE MILE DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-3994
Mailing Address - Country:US
Mailing Address - Phone:775-786-5670
Mailing Address - Fax:
Practice Address - Street 1:1881 THREE MILE DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-3994
Practice Address - Country:US
Practice Address - Phone:775-786-5670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCRNA000057367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
R10054Medicare UPIN
101818Medicare ID - Type Unspecified