Provider Demographics
NPI:1891709481
Name:JOHNSON, MAUREEN DOROTHY (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:DOROTHY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 THORN BERRY PL
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-4311
Mailing Address - Country:US
Mailing Address - Phone:832-567-8713
Mailing Address - Fax:
Practice Address - Street 1:11 THORN BERRY PL
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-4311
Practice Address - Country:US
Practice Address - Phone:832-567-8713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT 04804133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX611332Medicare UPIN