Individual
LAURENCE MIKKEL JOHANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, RD, CD
Contact information
Practice address
12425 KNOLL RD, SUITE 110, ELM GROVE, WI 53122-2657
(262) 780-9788
Mailing address
W137N6915 MANOR HILLS BLVD, MENOMONEE FALLS, WI 53051-5272
(262) 532-0293
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
2045-29
WI
133V00000X
Registered Dietitian
963363
—
Other
Enumeration date
09/27/2007
Last updated
09/27/2007
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