Active NPI
Mary Ann Vanpilsum-Johnson, RD, LRD
- Registered Dietitian
- St Louis Park, MN
National Provider Identifier
1861022477
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 4172
- Practice address
- 2930 Quentin Ave
St Louis Park, MN 55416-1965 - Phone
- (612) 207-3545
- NPI assigned
- Jan 22, 2020
- Last updated
- Jan 22, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 4172 | MN | Primary |
Addresses
Primary practice location
2930 Quentin Ave
St Louis Park, MN 55416-1965
Mailing address
2930 Quentin Ave
St Louis Park, MN 55416-1965
Phone (612) 207-3545
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4172 | MN | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1579651200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1579651200000",
"number": "1861022477",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2930 QUENTIN AVE",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "554161965",
"telephone_number": "612-207-3545"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2930 QUENTIN AVE",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "554161965",
"telephone_number": "612-207-3545"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANPILSUM-JOHNSON",
"first_name": "MARY",
"middle_name": "ANN",
"credential": "RD, LRD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-01-22",
"last_updated": "2020-01-22",
"certification_date": "2020-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MN",
"license": "4172",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Louis Park, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.