Individual
DIANE DECILLIS JOHNSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
933 BRADBURY DR SE STE 2222, ALBUQUERQUE, NM 87106-4375
(505) 365-2146
Mailing address
675 TOWER AVE, SUITE 301, HARTFORD, CT 06112-1273
(860) 714-2750
(860) 714-8591
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
CNP54774
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
CT
Enumeration date
03/10/2009
Last updated
08/19/2020
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