Healthcare Provider Details

I. General information

NPI: 1134785652
Provider Name (Legal Business Name): KRISTINA MARIE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTINA MARIE WINTER

II. Dates (important events)

Enumeration Date: 05/10/2019
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVE
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-803-5163
  • Fax: 513-636-5887
Mailing address:
  • Phone: 513-803-5163
  • Fax: 513-636-5887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number390200000X
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD.7097
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: