Healthcare Provider Details

I. General information

NPI: 1992335251
Provider Name (Legal Business Name): JULIE LYNN HANN RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2020
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 E US HIGHWAY 6
VALPARAISO IN
46383-8947
US

IV. Provider business mailing address

4403 STAFORDSHIRE LN
VALPARAISO IN
46383-1229
US

V. Phone/Fax

Practice location:
  • Phone: 219-983-8502
  • Fax:
Mailing address:
  • Phone: 630-779-0507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number37002835A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: