Provider Demographics
NPI:1295982791
Name:JOHNSTON, NICOLE APRIL (DEM)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:APRIL
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:DEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 LELAND AVE
Mailing Address - Street 2:
Mailing Address - City:CANYONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97417-9789
Mailing Address - Country:US
Mailing Address - Phone:541-530-1821
Mailing Address - Fax:
Practice Address - Street 1:310 LELAND AVE
Practice Address - Street 2:
Practice Address - City:CANYONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97417-9789
Practice Address - Country:US
Practice Address - Phone:541-530-1821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay