MEDICARE: LISA JOHNSTON RN

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	163W00000X	Registered Nurse	4704191237	MI

General Provider Information

NPI Number	:	1790498509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA JOHNSTON RN

Provider Business Mailing Address
First Line	:	8555 IRISH MIST
Second Line	:
City	:	ONSTED
State	:	MI
Zip	:	49265-9309
Country	:	US
Telephone Number	:	517-581-5915
Fax Number	:	517-592-1975

Provider Business Practice Location Address
First Line	:	102 N MAIN ST
Second Line	:
City	:	BROOKLYN
State	:	MI
Zip	:	49230-8979
Country	:	US
Telephone Number	:	517-581-5915
Fax Number	:

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

Provider Enumeration Date	:	12/27/2022
Last Update Date	:	12/27/2022

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Directions to “ LISA JOHNSTON RN” Practice Location

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