Provider Demographics
NPI:1295290443
Name:ASCENSION ST. JOHN HOSPITAL
Entity type:Organization
Organization Name:ASCENSION ST. JOHN HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED CLINICAL DIETICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHANNSEN-WILK
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:313-343-3481
Mailing Address - Street 1:22201 MOROSS, STE. 270
Mailing Address - Street 2:
Mailing Address - City:DETRIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48236
Mailing Address - Country:US
Mailing Address - Phone:313-343-3481
Mailing Address - Fax:313-343-7937
Practice Address - Street 1:22201 MOROSS, STE. 270
Practice Address - Street 2:
Practice Address - City:DETRIOT
Practice Address - State:MI
Practice Address - Zip Code:48236
Practice Address - Country:US
Practice Address - Phone:313-343-3481
Practice Address - Fax:313-343-7937
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASCENSION ST. JOHN HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty