Provider Demographics
NPI:1871183806
Name:JOHNSON, LINNETTE
Entity Type:Individual
Prefix:
First Name:LINNETTE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19813 LEITERSBURG PIKE # 193
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-1445
Mailing Address - Country:US
Mailing Address - Phone:240-406-4857
Mailing Address - Fax:240-202-2476
Practice Address - Street 1:226 N POTOMAC ST
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-3813
Practice Address - Country:US
Practice Address - Phone:240-406-4857
Practice Address - Fax:240-202-2476
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-23
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
OTHEROtherOTHER