Provider Demographics
NPI:1285132662
Name:JOHNSON, ELAINE (RDN LDN)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:
Credentials:RDN LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 W GRANDVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-1101
Mailing Address - Country:US
Mailing Address - Phone:814-323-3920
Mailing Address - Fax:866-316-2981
Practice Address - Street 1:4512 PEACH ST STE 2
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-1369
Practice Address - Country:US
Practice Address - Phone:814-426-1370
Practice Address - Fax:866-316-2981
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-31
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN002780133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered