Provider Demographics
NPI:1689829178
Name:JOHNSON, DAWN M (MS, RD)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 S GRAHAM RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3538
Mailing Address - Country:US
Mailing Address - Phone:810-230-1633
Mailing Address - Fax:810-732-0029
Practice Address - Street 1:1409 S GRAHAM RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3538
Practice Address - Country:US
Practice Address - Phone:810-230-1633
Practice Address - Fax:810-732-0029
Is Sole Proprietor?:No
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIA76059Medicare UPIN
MI0B56098Medicare PIN