Healthcare Provider Details

I. General information

NPI: 1659913622
Provider Name (Legal Business Name): JULIE FONTAINE APPOLONIA DTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2019
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY DRIVE C, MAIL STOP 120 NF-U
PITTSBURGH PA
15240
US

IV. Provider business mailing address

UNIVERSITY DRIVE C, MAIL STOP 120 NF-U
PITTSBURGH PA
15240
US

V. Phone/Fax

Practice location:
  • Phone: 412-360-1184
  • Fax:
Mailing address:
  • Phone: 412-360-1184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code136A00000X
TaxonomyRegistered Dietetic Technician
License Number86021665
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: