Healthcare Provider Details

I. General information

NPI: 1568440378
Provider Name (Legal Business Name): JOHNNA JOLENE TURNER RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG 576-NCD JEFFERSON AVE MCDONALD ARMY COMMUNITY HOSPITAL
FORT EUSTIS VA
23604
US

IV. Provider business mailing address

101 SUNRISE BLUFF LN
SMITHFIELD VA
23430-2323
US

V. Phone/Fax

Practice location:
  • Phone: 757-314-7755
  • Fax: 757-314-7758
Mailing address:
  • Phone: 254-220-2789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT06565
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: