Individual
TERRA RACHELLE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, RDN, IBCLC
Contact information
Practice address
3830 E VAN BUREN ST, PHOENIX, AZ 85008-6920
(602) 323-3344
(602) 323-3496
Mailing address
3003 N CENTRAL AVE STE 1600, PHOENIX, AZ 85012-2908
(602) 323-3344
(602) 323-3496
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86277803
AZ
174N00000X
Lactation Consultant (Non-RN)
L-56576
AZ
Other
Enumeration date
03/18/2015
Last updated
10/30/2024
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