Healthcare Provider Details

I. General information

NPI: 1851792428
Provider Name (Legal Business Name): JULIA MUTTER RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2014
Last Update Date: 09/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4364 MORNINGWOOD DR
OLNEY MD
20832-2829
US

IV. Provider business mailing address

4364 MORNINGWOOD DR
OLNEY MD
20832-2829
US

V. Phone/Fax

Practice location:
  • Phone: 202-437-0641
  • Fax:
Mailing address:
  • Phone: 202-437-0641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberD02310
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI100000110
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: