Healthcare Provider Details

I. General information

NPI: 1629676283
Provider Name (Legal Business Name): JUSTON JOHNSTON FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 WARDENBURG DRIVE
BOULDER CO
80309-3047
US

IV. Provider business mailing address

3154 FEDERAL BLVD
DENVER CO
80211-3745
US

V. Phone/Fax

Practice location:
  • Phone: 303-492-5101
  • Fax: 303-492-6861
Mailing address:
  • Phone: 804-350-7966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0995855-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: