Provider Demographics
NPI:1710649801
Name:JOHNSON, ERIN JESSIE (RDN)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:JESSIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:MS
Other - First Name:ERIN
Other - Middle Name:JESSIE
Other - Last Name:DIEDERICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:W168N9096 GARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-2114
Mailing Address - Country:US
Mailing Address - Phone:920-266-7509
Mailing Address - Fax:
Practice Address - Street 1:2301 N LAKE DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4508
Practice Address - Country:US
Practice Address - Phone:414-585-1321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered