Provider Demographics
NPI:1912119090
Name:JOHNSTONW, GLORIA (RN)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:
Last Name:JOHNSTONW
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6510 W BROWN ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-1022
Mailing Address - Country:US
Mailing Address - Phone:602-257-3841
Mailing Address - Fax:602-257-6397
Practice Address - Street 1:330 N 16TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85007-2443
Practice Address - Country:US
Practice Address - Phone:602-257-3841
Practice Address - Fax:602-257-6397
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN092378390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program