Provider Demographics
NPI:1740460914
Name:JOHNSTON, DENNIS O (CRNA)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:O
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 GROW AVE NW
Mailing Address - Street 2:A-9
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-1754
Mailing Address - Country:US
Mailing Address - Phone:206-842-7925
Mailing Address - Fax:
Practice Address - Street 1:350 GROW AVE NW
Practice Address - Street 2:A-9
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-1754
Practice Address - Country:US
Practice Address - Phone:206-842-7925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP 30005029367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered