Provider Demographics
NPI:1396779534
Name:JOHNSTON, CATHERINE BREE
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:BREE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BREE
Other - Middle Name:
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD , MPH
Mailing Address - Street 1:2800 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-8358
Mailing Address - Country:US
Mailing Address - Phone:360-296-0639
Mailing Address - Fax:
Practice Address - Street 1:1415 E KINCAID ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4126
Practice Address - Country:US
Practice Address - Phone:360-424-4111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60229218207R00000X, 207RG0300X, 207RH0002X
CAG058563207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0282881OtherL&I AND CRIME VICTIMS
CAG058563OtherLICENSE NUMBER
CABJ0816782OtherDEA
WA0559JOOtherREGENCE BLUE SHIELD
WA0282881OtherL&I AND CRIME VICTIMS
WA1396779534Medicaid
CABJ0816782OtherDEA
WAG8902672Medicare UPIN