Healthcare Provider Details

I. General information

NPI: 1699104828
Provider Name (Legal Business Name): MAUREEN JOHNSTON NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2013
Last Update Date: 11/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 CARLETON ST E23
CAMBRIDGE MA
02142-1323
US

IV. Provider business mailing address

25 CARLETON ST E23
CAMBRIDGE MA
02142-1323
US

V. Phone/Fax

Practice location:
  • Phone: 617-253-7625
  • Fax: 617-253-6373
Mailing address:
  • Phone: 617-253-7625
  • Fax: 617-253-6373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN234321
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: