Healthcare Provider Details

I. General information

NPI: 1942593140
Provider Name (Legal Business Name): JULIE HOVENCAMP RDN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2011
Last Update Date: 01/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 BROADWAY BLDG 3
BANGOR ME
04401-1900
US

IV. Provider business mailing address

PO BOX 934
BANGOR ME
04402-0934
US

V. Phone/Fax

Practice location:
  • Phone: 207-907-1187
  • Fax: 207-907-1189
Mailing address:
  • Phone: 207-907-1187
  • Fax: 207-907-1189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI1015
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: