Provider Demographics
NPI:1982387007
Name:JOHNSTON, NIA G
Entity type:Individual
Prefix:
First Name:NIA
Middle Name:G
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 1:2022 MARYLAND AVE NE APT 104
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-3119
Mailing Address - Country:US
Mailing Address - Phone:202-374-8722
Mailing Address - Fax:
Practice Address - Street 1:2022 MARYLAND AVE NE APT 104
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-3119
Practice Address - Country:US
Practice Address - Phone:202-374-8722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant