Healthcare Provider Details

I. General information

NPI: 1871497719
Provider Name (Legal Business Name): MARY JOHNSON MDN, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CHILDRENS DR
COLUMBUS OH
43205-2664
US

IV. Provider business mailing address

4920 MCPARTLAN CT
COLUMBUS OH
43221-5231
US

V. Phone/Fax

Practice location:
  • Phone: 614-722-0759
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD.11773
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: