Individual
MRS. MARY E JOHNSTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
411 N SECTION ST, FAIRHOPE, AL 36532
(251) 660-3470
(251) 660-3471
Mailing address
407 KUMQUAT ST, FAIRHOPE, AL 36532-1246
(251) 581-2445
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA-393
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008087700
—
FL
01
—
51593844
BCBS - 575 STANTON RD
AL
01
—
51593935
BCBS - 1720 CENTER ST
AL
Enumeration date
07/13/2006
Last updated
06/03/2019
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