Laurence Mikkel Johansen, MS, RD, CD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

2045-29 Issued in WI

Practice address

12425 Knoll Rd
Suite 110
Elm Grove, WI 53122-2657

Phone

(262) 780-9788

NPI assigned

Sep 27, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Larry Johansen Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1190851200000",
    "number": "1487841979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W137N6915 MANOR HILLS BLVD",
            "city": "MENOMONEE FALLS",
            "state": "WI",
            "postal_code": "530515272",
            "telephone_number": "262-532-0293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12425 KNOLL RD",
            "address_2": "SUITE 110",
            "city": "ELM GROVE",
            "state": "WI",
            "postal_code": "531222657",
            "telephone_number": "262-780-9788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHANSEN",
        "first_name": "LAURENCE",
        "middle_name": "MIKKEL",
        "credential": "MS, RD, CD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-09-27",
        "last_updated": "2007-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "WI",
            "license": "2045-29",
            "primary": true
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": "963363",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LARRY",
            "last_name": "JOHANSEN",
            "credential": "MS, RD, CD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Robert Anthony Hyndiuk, M.D.
• Christine Jablonski, L.AC
• David Howard Jadin, D.D.S.
• Jensen Health & Energy Center, S.C.
• Jir Psychiatry
• Margaret Jones, L.AC.
• Thomas Roderick Jones, RPH
• Virginia Marie Jurken, PT
• Kaaya Medicine
• Jaime Kawczynski

• All providers in Elm Grove, WI
• Registered Dietitian in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.