Provider Demographics
NPI:1679174122
Name:JOHNSON, ERIKA MARIE (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 FRANKLIN ST STE 180
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-4341
Mailing Address - Country:US
Mailing Address - Phone:814-534-6800
Mailing Address - Fax:
Practice Address - Street 1:1111 FRANKLIN ST STE 180
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-4341
Practice Address - Country:US
Practice Address - Phone:814-534-6800
Practice Address - Fax:814-534-6937
Is Sole Proprietor?:No
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN006564133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered