Healthcare Provider Details

I. General information

NPI: 1811478886
Provider Name (Legal Business Name): MCKENZIE LIN JOHNSON RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 08/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 W MAIN ST
WHITE SULPHUR SPRINGS MT
59645-9036
US

IV. Provider business mailing address

430 S 7TH ST
LIVINGSTON MT
59047-3437
US

V. Phone/Fax

Practice location:
  • Phone: 406-547-3321
  • Fax:
Mailing address:
  • Phone: 406-223-0940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: