Healthcare Provider Details

I. General information

NPI: 1528436474
Provider Name (Legal Business Name): JULIE YAEGER RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2015
Last Update Date: 09/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 MCFARLAN RD SUITE 102
KENNETT SQUARE PA
19348-2453
US

IV. Provider business mailing address

233 E LANCASTER AVE STE 305
ARDMORE PA
19003-2321
US

V. Phone/Fax

Practice location:
  • Phone: 610-444-5678
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN004773
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: