Individual
KOURTNEY J JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LD
Contact information
Practice address
3962 143RD ST W, ROSEMOUNT, MN 55068-4060
(612) 214-1635
Mailing address
3962 143RD ST W, ROSEMOUNT, MN 55068-4060
(612) 214-1635
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
4158
MN
Other
Enumeration date
11/10/2020
Last updated
11/10/2020
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