Provider Demographics
NPI:1912900127
Name:JOHNSTON, WAYNE ANDREW (CRNA)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:ANDREW
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:CRNA
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 3279
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81302-3279
Mailing Address - Country:US
Mailing Address - Phone:970-247-9606
Mailing Address - Fax:
Practice Address - Street 1:28 HUNTER CT
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7252
Practice Address - Country:US
Practice Address - Phone:970-247-9606
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO95055367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered