Provider Demographics
NPI:1649357443
Name:JOHNSTON, MARIA ELENA (DNAP, CRNA)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:ELENA
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:DNAP, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33155 ANNAPOLIS ST
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:MI
Mailing Address - Zip Code:48184-2405
Mailing Address - Country:US
Mailing Address - Phone:734-467-4667
Mailing Address - Fax:734-467-2303
Practice Address - Street 1:33155 ANNAPOLIS ST
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-2405
Practice Address - Country:US
Practice Address - Phone:734-467-4667
Practice Address - Fax:734-467-2303
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CRNA.0020289367500000X
MI4704180960367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4720000Medicaid
MI4171070Medicaid
MI4343657Medicaid
MI0N21370040Medicare ID - Type Unspecified
MI430053928Medicare ID - Type UnspecifiedRAILROAD
MI4343657Medicaid
MI0E06150107Medicare ID - Type Unspecified
MI4720000Medicaid