Provider Demographics
NPI:1144353335
Name:JOHNSTON, ELIZABETH K (PA C)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:K
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5424 E SOUTHERN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-3621
Mailing Address - Country:US
Mailing Address - Phone:480-654-6200
Mailing Address - Fax:480-654-6214
Practice Address - Street 1:5424 E SOUTHERN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3621
Practice Address - Country:US
Practice Address - Phone:480-654-6200
Practice Address - Fax:480-654-6214
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ3268363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant