Provider Demographics
NPI:1962115204
Name:JOHNSON, OLIVIA (RD)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14445 35TH AVE APT 4M
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-3640
Mailing Address - Country:US
Mailing Address - Phone:860-790-7523
Mailing Address - Fax:
Practice Address - Street 1:14 HOLLY ST
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-1712
Practice Address - Country:US
Practice Address - Phone:781-264-6877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-02
Last Update Date:2025-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist