Provider Demographics
NPI:1912209610
Name:DONNENFIELD, JOHANNA (RD)
Entity Type:Individual
Prefix:MS
First Name:JOHANNA
Middle Name:
Last Name:DONNENFIELD
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8014 E DAVENPORT DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3520
Mailing Address - Country:US
Mailing Address - Phone:480-227-9306
Mailing Address - Fax:480-368-9456
Practice Address - Street 1:8014 E DAVENPORT DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-3520
Practice Address - Country:US
Practice Address - Phone:480-227-9306
Practice Address - Fax:480-368-9456
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ836794133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered