Provider Demographics
NPI:1710771753
Name:JOHANON, EMMA KATE (MBA, RDN)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:KATE
Last Name:JOHANON
Suffix:
Gender:
Credentials:MBA, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48206-2084
Mailing Address - Country:US
Mailing Address - Phone:313-623-7584
Mailing Address - Fax:
Practice Address - Street 1:1720 TAYLOR ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48206-2084
Practice Address - Country:US
Practice Address - Phone:313-623-7584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered