Laurence Mikkel Johansen, MS, RD, CD

NPI #1487841979 in Elm Grove, Wisconsin

Provider Information

NPI Number: 1487841979
Entity Type: Individual
Name: Laurence Mikkel Johansen, MS, RD, CD
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Dietitian, Registered
Credential: MS, RD, CD
Enumeration Date: Sep 27, 2007
Last Updated: Sep 27, 2007

Practice Location

Address: 12425 KNOLL RD
Address 2: SUITE 110
City: Elm Grove
State: Wisconsin
ZIP Code: 53122-2657
Phone: (262) 780-9788

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dietitian, Registered	133V00000X	Primary

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