Basic Information
| Provider Information | |||||||||
| NPI: | 1699714923 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | SARA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | RD, LD, CDE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3300 OAKDALE AVE N | ||||||||
| Address2: | |||||||||
| City: | ROBBINSDALE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554222926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635202000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9855 HOSPITAL DR STE 102 | ||||||||
| Address2: | |||||||||
| City: | MAPLE GROVE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553694648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635815800 | ||||||||
| FaxNumber: | 7635815801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2006 | ||||||||
| LastUpdateDate: | 01/25/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133VN1006X | 1944 | MN | Y | Dietary & Nutritional Service Providers | Dietitian, Registered | Nutrition, Metabolic |
ID Information
| ID | Type | State | Issuer | Description | 6300309 | 01 | MN | MEDICA | OTHER | 900233283 | 01 | MN | RR MEDICARE | OTHER | 2182695 | 01 | FM | AMERICA'S PPO | OTHER | 6300309 | 01 | MN | SELECT CARE | OTHER |