Healthcare Provider Details

I. General information

NPI: 1316256696
Provider Name (Legal Business Name): JOANNE JOHNSTON A.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 12/27/2022
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

389 W 29TH AVE
EUGENE OR
97405-2726
US

IV. Provider business mailing address

389 W 29TH AVE
EUGENE OR
97405-2726
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2900
  • Fax:
Mailing address:
  • Phone: 541-683-3618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number085070560N3
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberCNP01111
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberCNP01111
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: