Provider Demographics
NPI:1679322424
Name:JOHNSON, AARON BLAKELEY (RDN)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:BLAKELEY
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 S MIDVALE BLVD APT 226
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-1470
Mailing Address - Country:US
Mailing Address - Phone:262-993-3918
Mailing Address - Fax:
Practice Address - Street 1:801 BRAXTON PL FL 2
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1415
Practice Address - Country:US
Practice Address - Phone:608-260-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered