Provider Demographics
NPI:1073118493
Name:ALFORD, JOHNA (CHN)
Entity Type:Individual
Prefix:
First Name:JOHNA
Middle Name:
Last Name:ALFORD
Suffix:
Gender:F
Credentials:CHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 COUNTY ROAD 314
Mailing Address - Street 2:
Mailing Address - City:ROCKDALE
Mailing Address - State:TX
Mailing Address - Zip Code:76567-5007
Mailing Address - Country:US
Mailing Address - Phone:979-406-0101
Mailing Address - Fax:
Practice Address - Street 1:413 COUNTY ROAD 314
Practice Address - Street 2:
Practice Address - City:ROCKDALE
Practice Address - State:TX
Practice Address - Zip Code:76567-5007
Practice Address - Country:US
Practice Address - Phone:979-406-0101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist