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NPI Code Detail

MEDICARE: MCKENZIE LIN JOHNSON RDN

MEDICARE: MCKENZIE LIN JOHNSON RDN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian

General Provider Information

NPI Number : 1811478886
Entity Type Code : Individual
Provider Name (Legal Business Name) : MCKENZIE LIN JOHNSON RDN
Provider Business Mailing Address
First Line : 430 S 7TH ST
Second Line :
City : LIVINGSTON
State : MT
Zip : 59047-3437
Country : US
Telephone Number : 406-223-0940
Fax Number :
Provider Business Practice Location Address
First Line : 16 W MAIN ST
Second Line :
City : WHITE SULPHUR SPRINGS
State : MT
Zip : 59645-9036
Country : US
Telephone Number : 406-547-3321
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/27/2018
Last Update Date : 08/27/2018

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