Individual
MRS. LORI JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.D.,L.D
Contact information
Practice address
1224 8TH ST, RUPERT, ID 83350-1527
(208) 436-0481
(208) 436-6038
Mailing address
239 N 200 W, RUPERT, ID 83350-9358
(208) 436-8355
(208) 436-6038
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
D-438
ID
Other
Enumeration date
09/16/2006
Last updated
07/08/2007
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