Provider Demographics
NPI:1689160616
Name:JOHANNA RICHTER NUTRITION WELLNESS LLC
Entity Type:Organization
Organization Name:JOHANNA RICHTER NUTRITION WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHANNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RICHTER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN
Authorized Official - Phone:312-715-7797
Mailing Address - Street 1:1752 NW MARKET ST # 4110
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-5264
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 W HARRISON ST STE 140
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-4116
Practice Address - Country:US
Practice Address - Phone:206-880-0108
Practice Address - Fax:888-789-6982
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHANNA RICHTER NUTRITION WELLNESS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-02
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60850685133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty