Provider Demographics
NPI:1831806215
Name:JOHNSON, SHERI LYNN (RD)
Entity type:Individual
Prefix:
First Name:SHERI
Middle Name:LYNN
Last Name:JOHNSON
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 1:953 WINEBERRY LN
Mailing Address - Street 2:
Mailing Address - City:MOSS BLUFF
Mailing Address - State:LA
Mailing Address - Zip Code:70611-6084
Mailing Address - Country:US
Mailing Address - Phone:214-223-5134
Mailing Address - Fax:
Practice Address - Street 1:3440 E LA PALMA AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-2020
Practice Address - Country:US
Practice Address - Phone:714-644-7979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
949262133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered