Individual
JOHN GRADY JOHNSTON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DNP
Contact information
Practice address
42121 US HIGHWAY 70, PORTALES, NM 88130-9054
(575) 359-1800
Mailing address
506 VIALE BOND, ROSWELL, NM 88201-5874
(731) 616-8164
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041465807
IL
367500000X
Certified Registered Nurse Anesthetist
120003
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
55422
NM
Other
Enumeration date
07/18/2018
Last updated
04/03/2024
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