Healthcare Provider Details

I. General information

NPI: 1417354911
Provider Name (Legal Business Name): YVONNE A JOHNSTON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2014
Last Update Date: 11/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 FRONT ST
BINGHAMTON NY
13905-2474
US

IV. Provider business mailing address

PO BOX 6000 BINGHAMTON UNIVERSITY - DECKER SCHOOL OF NURSING
BINGHAMTON NY
13902-6000
US

V. Phone/Fax

Practice location:
  • Phone: 607-778-2839
  • Fax: 607-778-2873
Mailing address:
  • Phone: 607-777-2622
  • Fax: 607-777-4440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number455113-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF331837-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: