Healthcare Provider Details

I. General information

NPI: 1144819905
Provider Name (Legal Business Name): JENNA JOHNSTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2021
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SUDLAGER 51
HOHENFELS BAYERN
92366
DE

IV. Provider business mailing address

CMR 414 BOX 2757
APO AE
09173-0028
US

V. Phone/Fax

Practice location:
  • Phone: 63-719-4643
  • Fax:
Mailing address:
  • Phone: 152-092-1933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number929150
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: