Provider Demographics
NPI:1114717188
Name:JOHNSTON, NICHOLAS TODD (CST)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:TODD
Last Name:JOHNSTON
Suffix:
Gender:
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3610 HAT ROCK CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-5046
Mailing Address - Country:US
Mailing Address - Phone:928-241-8531
Mailing Address - Fax:
Practice Address - Street 1:3012 S DURANGO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-9186
Practice Address - Country:US
Practice Address - Phone:792-901-4233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV188168246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant