Provider Demographics
NPI:1528149598
Name:JOHNSTONE, JACQUELINE J (CNM)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:J
Last Name:JOHNSTONE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 748860
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-4679
Mailing Address - Country:US
Mailing Address - Phone:480-644-1001
Mailing Address - Fax:480-464-8722
Practice Address - Street 1:4824 E BASELINE RD STE 129
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4679
Practice Address - Country:US
Practice Address - Phone:480-644-1001
Practice Address - Fax:480-464-8722
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7422367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ042807Medicaid
AZ042807Medicaid
PABU1905682OtherHIGHMARK BLUE SHIELD
PA1017418310001Medicaid
PABU1905682OtherHIGHMARK BLUE SHIELD