Healthcare Provider Details

I. General information

NPI: 1396861290
Provider Name (Legal Business Name): MARSHA A JOHNSON CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3071 COUNTY COMPLEX DR
CANANDAIGUA NY
14424-9505
US

IV. Provider business mailing address

1389 BRICK CHURCH RD
ONTARIO NY
14519-9739
US

V. Phone/Fax

Practice location:
  • Phone: 585-394-4620
  • Fax: 585-394-1987
Mailing address:
  • Phone: 315-524-6225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number0032061
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: