Provider Demographics
NPI:1144819905
Name:JOHNSTON, JENNA (RN)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 414 BOX 2757
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09173-0028
Mailing Address - Country:US
Mailing Address - Phone:152-092-1933
Mailing Address - Fax:
Practice Address - Street 1:SUDLAGER 51
Practice Address - Street 2:
Practice Address - City:HOHENFELS
Practice Address - State:BAYERN
Practice Address - Zip Code:92366
Practice Address - Country:DE
Practice Address - Phone:063-719-4643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX929150163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse