Healthcare Provider Details

I. General information

NPI: 1679400527
Provider Name (Legal Business Name): MIA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 RED BANK RD
CINCINNATI OH
45227-2176
US

IV. Provider business mailing address

4440 RED BANK RD
CINCINNATI OH
45227-2176
US

V. Phone/Fax

Practice location:
  • Phone: 513-585-2668
  • Fax:
Mailing address:
  • Phone: 513-585-2668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD.10717
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: