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General NPI Number Information
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NPI Number | 1508170051
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Entity Type | Individual
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Provider Name | MICHELE JOHNSTON NP
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Gender | Female
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Dates
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Enumeration Date | 07/27/2010
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Last Update Date | 12/04/2019
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Provider Practice Location Address
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Address Line | 105 CANAL LANDING BLVD STE 1
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City | ROCHESTER
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State | NY
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Zip | 14626-5107
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Country | US
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Telephone | 585-368-4050
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Fax | 585-723-6705
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Provider Business Mailing Address
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Address Line | 470 COLLINS ST
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City | AVON
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State | NY
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Zip | 14414-1466
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Country | US
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Telephone | 585-226-2640
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Fax | 585-226-2206
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 307831
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 307831
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License Number State | NY
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