Provider Demographics
NPI:1609629898
Name:JOHNSON, PATRICIA J (RD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:J
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3660 W FAIRVIEW LN
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-4924
Mailing Address - Country:US
Mailing Address - Phone:480-861-1076
Mailing Address - Fax:
Practice Address - Street 1:6124 E BROWN RD STE 102
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-4959
Practice Address - Country:US
Practice Address - Phone:480-809-6513
Practice Address - Fax:480-809-6823
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered