Healthcare Provider Details

I. General information

NPI: 1922799147
Provider Name (Legal Business Name): JULIANA ROYSE RD, LD, CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 05/18/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR
MORGANTOWN WV
26506-1200
US

IV. Provider business mailing address

1 MEDICAL CENTER DRIVE PO BOX 8241
MORGANTOWN WV
26506
US

V. Phone/Fax

Practice location:
  • Phone: 304-598-4391
  • Fax: 304-598-4941
Mailing address:
  • Phone: 304-598-4391
  • Fax: 304-598-4941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1113
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: