| Laurence Mikkel Johansen, MS, RD, CD | |
|
12425 Knoll Rd, Suite 110, Elm Grove, WI 53122-2657 | |
| (262) 780-9788 | |
| Not Available |
| Full Name | Laurence Mikkel Johansen |
|---|---|
| Gender | Male |
| Speciality | Dietitian, Registered |
| Location | 12425 Knoll Rd, Elm Grove, Wisconsin |
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487841979 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 133V00000X | Dietitian, Registered | 2045-29 (Wisconsin) | Primary |
| 133V00000X | Dietitian, Registered | 963363 (* (Not Available)) | Secondary |
| Mailing Address | Practice Location Address |
|---|---|
| Laurence Mikkel Johansen, MS, RD, CD W137n6915 Manor Hills Blvd, Menomonee Falls, WI 53051-5272 Ph: (262) 532-0293 | Laurence Mikkel Johansen, MS, RD, CD 12425 Knoll Rd, Suite 110, Elm Grove, WI 53122-2657 Ph: (262) 780-9788 |
Samantha Faye Kuspa, RDN, CD, LD Dietitian Medicare: Not Enrolled in Medicare Practice Location: 890 Elm Grove Rd Ste 100, Elm Grove, WI 53122 Phone: 262-352-6050 | |
Erica Leigh Gutierrez, RDN Dietitian Medicare: Not Enrolled in Medicare Practice Location: 820 Terrace Dr, Elm Grove, WI 53122 Phone: 920-851-6431 |