Individual
WENDY J. JOHNSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
49 SPRING ST, 1ST FLOOR, SCARBOROUGH, ME 04074-8926
(207) 885-4479
(207) 883-2586
Mailing address
301 US ROUTE 1, BUILDING C, SCARBOROUGH, ME 04074-7609
(207) 396-8600
(207) 396-8632
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA-539
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
293000099
—
ME
Enumeration date
06/16/2006
Last updated
03/24/2011
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