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Individual

BETHANNE JOHNSTON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
705 RILEY HOSPITAL DR, INDIANAPOLIS, IN 46202-5109
(317) 944-2563
(317) 222-2154
Mailing address
PO BOX 778912, CHICAGO, IL 60677-8912
(317) 777-6435
(317) 777-6644

Taxonomy

Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
28106651
IN
363LP0200X
Pediatric Nurse Practitioner
Primary
71001903
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200850390
IN
Enumeration date
11/01/2006
Last updated
12/05/2023
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