Healthcare Provider Details

I. General information

NPI: 1407922248
Provider Name (Legal Business Name): JULIE LYNNE SMITH RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 DECATUR ST
SANDUSKY OH
44870-3335
US

IV. Provider business mailing address

7 KATHERINE WAY
NORWALK OH
44857-8972
US

V. Phone/Fax

Practice location:
  • Phone: 419-557-7431
  • Fax:
Mailing address:
  • Phone: 419-668-8124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number809552
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: