Provider Demographics
NPI:1356075360
Name:JOHNSON, MARISSA (MS, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 636
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03076-0636
Mailing Address - Country:US
Mailing Address - Phone:603-685-4309
Mailing Address - Fax:
Practice Address - Street 1:90 WASHINGTON ST STE 203
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-3759
Practice Address - Country:US
Practice Address - Phone:603-685-4309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-14
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1337133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered