Provider Demographics
NPI:1699104828
Name:JOHNSTON, MAUREEN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CARLETON ST
Mailing Address - Street 2:E23
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02142-1323
Mailing Address - Country:US
Mailing Address - Phone:617-253-7625
Mailing Address - Fax:617-253-6373
Practice Address - Street 1:25 CARLETON ST
Practice Address - Street 2:E23
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02142-1323
Practice Address - Country:US
Practice Address - Phone:617-253-7625
Practice Address - Fax:617-253-6373
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN234321363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care