| Doctor Name: | LAURENCE MIKKEL JOHANSEN |
| NPI Number: | 1487841979 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MS, RD, CD |
| License Number: | 963363 |
| Business Practice Address: | 12425 Knoll Rd Suite 110 Elm Grove, WI - 531222657 |
| Business Phone Number: | 2627809788 |
| Business Fax Number: | |
| Mailing Address: | W137n6915 Manor Hills Blvd, MENOMONEE FALLS |
| State: | WI |
| Postal Code: | 530515272 |
| Phone Number: | 2625320293 |
| Fax Number: | |
| NPI Enumeration Date: | 09/27/2007 |
| NPI Last Update Date: | 09/27/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | 963363 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |