Provider Demographics
NPI:1700539798
Name:JOHNSTON, MARIA LYNN (CRNP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:LYNN
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 BEAVER DR BLDG C
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-2440
Mailing Address - Country:US
Mailing Address - Phone:814-371-2273
Mailing Address - Fax:814-371-2500
Practice Address - Street 1:90 BEAVER DR BLDG C
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2440
Practice Address - Country:US
Practice Address - Phone:814-371-2273
Practice Address - Fax:814-371-2500
Is Sole Proprietor?:No
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP025302363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care