Provider Demographics
NPI:1760528293
Name:MAUREEN K JOHNSON, REGISTERED DIETITIAN, INC.
Entity Type:Organization
Organization Name:MAUREEN K JOHNSON, REGISTERED DIETITIAN, INC.
Other - Org Name:MKJRD, INC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, R D
Authorized Official - Phone:307-745-4026
Mailing Address - Street 1:PO BOX 1800
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82073-1800
Mailing Address - Country:US
Mailing Address - Phone:307-745-4026
Mailing Address - Fax:307-745-4026
Practice Address - Street 1:2010 REYNOLDS ST
Practice Address - Street 2:#H280
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-2481
Practice Address - Country:US
Practice Address - Phone:307-745-4026
Practice Address - Fax:307-745-4026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X, 171M00000X
WY251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
Not Answered171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Multi-Specialty