Provider Demographics
NPI:1285135731
Name:DIETITIAN DANIELLE LLC
Entity type:Organization
Organization Name:DIETITIAN DANIELLE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:281-947-2731
Mailing Address - Street 1:951 FM 646 RD E STE A8
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-5597
Mailing Address - Country:US
Mailing Address - Phone:281-947-2731
Mailing Address - Fax:281-215-5104
Practice Address - Street 1:951 FM 646 RD E STE A8
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-5597
Practice Address - Country:US
Practice Address - Phone:281-947-2731
Practice Address - Fax:281-215-5104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-21
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT84520133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1871008193OtherNPI TYPE 1
TXDT84520OtherLICENSE