MEDICARE: MARY JOAN JOHNSTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	16990	NE

General Provider Information

NPI Number	:	1750880563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY JOAN JOHNSTON

Provider Business Mailing Address
First Line	:	2772 S 39TH ST
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68506-3234
Country	:	US
Telephone Number	:	402-480-1744
Fax Number	:	402-436-1655

Provider Business Practice Location Address
First Line	:	2772 S 39TH ST
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68506-3234
Country	:	US
Telephone Number	:	402-480-1744
Fax Number	:	402-436-1655

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2018
Last Update Date	:	02/07/2018

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Directions to “ MARY JOAN JOHNSTON ” Practice Location

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