Provider Demographics
NPI:1225551864
Name:JOHNSON, JOHANNA LYN (RD)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:LYN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 E 19TH AVE RM 722
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1114
Mailing Address - Country:US
Mailing Address - Phone:303-812-2312
Mailing Address - Fax:
Practice Address - Street 1:1960 N OGDEN ST STE 460
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-3670
Practice Address - Country:US
Practice Address - Phone:303-318-2581
Practice Address - Fax:303-318-2536
Is Sole Proprietor?:No
Enumeration Date:2017-07-25
Last Update Date:2017-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered