Lori Johnson, R.D.,L.D
Individual provider Active NPI Registered Dietitian · Rupert, ID
NPI 1669578472 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1669578472
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- D-438 (ID)
- Practice address
- 1224 8TH St
Rupert, ID 83350-1527 - Phone
- (208) 436-0481
- Fax
- (208) 436-6038
- NPI assigned
- Sep 16, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | D-438 | ID | Yes |
Addresses
Primary practice location
1224 8TH St
Rupert, ID 83350-1527
Mailing address
239 N 200 W
Rupert, ID 83350-9358
Phone (208) 436-8355
Other providers in Rupert, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.