Healthcare Provider Details

I. General information

NPI: 1811793243
Provider Name (Legal Business Name): JULI JOHNSON N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10832 EAGLE COVE DR
SOUTH LYON MI
48178-9586
US

IV. Provider business mailing address

10832 EAGLE COVE DR
SOUTH LYON MI
48178-9586
US

V. Phone/Fax

Practice location:
  • Phone: 248-924-6501
  • Fax:
Mailing address:
  • Phone: 248-924-6501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: