Individual
MS. LISA J JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
113 CROCKED CREEK LANE, STANLEY, ID 83278
(208) 774-2864
Mailing address
POB 69, STANLEY, ID 83278
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
D-122
ID
Other
Enumeration date
08/13/2021
Last updated
08/13/2021
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