Provider Demographics
NPI:1104133065
Name:JOHNSTON, FERNANDA LEITE
Entity type:Individual
Prefix:
First Name:FERNANDA
Middle Name:LEITE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6497 VANHOVEN CREST ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166-2016
Mailing Address - Country:US
Mailing Address - Phone:615-668-4665
Mailing Address - Fax:
Practice Address - Street 1:2183 W MAIN ST # A209
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-6760
Practice Address - Country:US
Practice Address - Phone:385-469-2120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9552826163W00000X
NV870445363LP0808X
TN32187363LP0808X
UT13423930-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse