| NPI | 1962750802 |
|---|---|
| Former Name | TERRI KELLER JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: 867915) |
| Additional Taxonomies | 133N00000X Nutritionist (Licence: LA 867915) |
| 133N00000X Nutritionist (Licence: LA 1273) | |
| 133V00000X Dietitian, Registered (Licence: LA 1273) | |
| Enumeration Date | 2012-08-27 |
| Last Update Date | 2022-07-21 |