Individual
MRS. TAMARA LYNN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MED, RD,LD,CDE
Contact information
Practice address
525 MADRONA AVE, PORT ORFORD, OR 97465-9552
(541) 332-3861
Mailing address
525 MADRONA AVE, PORT ORFORD, OR 97465-9552
(541) 332-3861
(541) 332-0250
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD-D-10203616
OR
Other
Enumeration date
11/29/2019
Last updated
11/29/2019
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