Healthcare Provider Details

I. General information

NPI: 1356815674
Provider Name (Legal Business Name): MS. BRIANNA JOHNSTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2019
Last Update Date: 01/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45-955 KAMEHAMEHA HWY
KANEOHE HI
96744-3222
US

IV. Provider business mailing address

47-416A WAIHEE RD
KANEOHE HI
96744-4951
US

V. Phone/Fax

Practice location:
  • Phone: 808-247-2973
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: