Provider Demographics
NPI:1366547895
Name:JOHNSON, MARGHERITA MARIE (RD)
Entity type:Individual
Prefix:
First Name:MARGHERITA
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8912 MARSHFIELD LN
Mailing Address - Street 2:
Mailing Address - City:ORLAND HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60477-4660
Mailing Address - Country:US
Mailing Address - Phone:708-525-8525
Mailing Address - Fax:
Practice Address - Street 1:18425 W WEST CREEK DR STE G
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-6768
Practice Address - Country:US
Practice Address - Phone:708-532-1337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered