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General NPI Number Information
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NPI Number | 1922129824
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Entity Type | Individual
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Provider Name | MARY JOHNSTON RD LD
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Gender | Female
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 08/07/2014
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Provider Practice Location Address
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Address Line | 1160 W BROAD ST LOWER LIGHTS CHRISTIAN HEALTH CENTER
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City | COLUMBUS
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State | OH
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Zip | 43222-1317
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Country | US
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Telephone | 614-274-1455
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Fax | 614-274-2040
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Provider Business Mailing Address
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Address Line | 1160 W BROAD ST LOWER LIGHTS CHRISTIAN HEALTH CENTER
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City | COLUMBUS
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State | OH
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Zip | 43222-1317
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Country | US
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Telephone | 614-274-1455
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Fax | 614-274-2040
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | LD2555
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License Number State | OH
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