Healthcare Provider Details

I. General information

NPI: 1588497192
Provider Name (Legal Business Name): KRISTINE HNATYSHYN JOHNSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 03/05/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVENUE, BOSTON CHILDREN'S HOSPITAL MAILSTOP 3220
BOSTON MA
02115
US

IV. Provider business mailing address

C/O MICHELLE GUEVARA, DEPARTMENT OF ORTHOPEDICS & SPORT 300 LONGWOOD AVENUE BCH 3220
BOSTON MA
02115
US

V. Phone/Fax

Practice location:
  • Phone: 857-218-4924
  • Fax: 617-730-0459
Mailing address:
  • Phone: 857-215-4924
  • Fax: 617-730-0459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number3015971
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: