Provider Demographics
NPI:1720146772
Name:GOLSTON, JOHANNA POWDEN (RN, NP)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:POWDEN
Last Name:GOLSTON
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:HINESBURG
Mailing Address - State:VT
Mailing Address - Zip Code:05461-9127
Mailing Address - Country:US
Mailing Address - Phone:805-610-4542
Mailing Address - Fax:
Practice Address - Street 1:595 DORSET ST STE 4
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6240
Practice Address - Country:US
Practice Address - Phone:802-489-5552
Practice Address - Fax:802-488-5465
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19126363LP0808X
VT101.0136722363LP0808X
CA647378163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse