Provider Demographics
NPI:1376781831
Name:HALL, JOHNNA L (RD, LMNT)
Entity Type:Individual
Prefix:
First Name:JOHNNA
Middle Name:L
Last Name:HALL
Suffix:
Gender:F
Credentials:RD, LMNT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-4733
Mailing Address - Country:US
Mailing Address - Phone:402-421-2462
Mailing Address - Fax:
Practice Address - Street 1:6001 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-4733
Practice Address - Country:US
Practice Address - Phone:402-421-2462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-21
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1263133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered