Provider Demographics
NPI:1710211164
Name:JOHNSTON, CHRISTOPHER NEVIN
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:NEVIN
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:
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 480
Mailing Address - Street 2:
Mailing Address - City:GUERNEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95446-0480
Mailing Address - Country:US
Mailing Address - Phone:707-565-1209
Mailing Address - Fax:707-565-2612
Practice Address - Street 1:16390 MAIN ST
Practice Address - Street 2:
Practice Address - City:GUERNEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95446-9677
Practice Address - Country:US
Practice Address - Phone:707-565-1209
Practice Address - Fax:707-565-2612
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-01
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1710211164Medicaid