Healthcare Provider Details

I. General information

NPI: 1982940680
Provider Name (Legal Business Name): KRYSTAL LYNN JOHNSTON R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. KRYSTAL LYNN KOLLN

II. Dates (important events)

Enumeration Date: 12/27/2012
Last Update Date: 12/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 E 44TH ST
TACOMA WA
98404
US

IV. Provider business mailing address

1708 E 44TH ST
TACOMA WA
98404-4611
US

V. Phone/Fax

Practice location:
  • Phone: 253-471-4553
  • Fax: 253-722-2184
Mailing address:
  • Phone: 253-471-4553
  • Fax: 253-722-2184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN60153474
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: