MEDICARE: JULIA NICOLINI RDN, LDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian
2	133V00000X	Registered Dietitian	164005374	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053847921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA NICOLINI RDN, LDN

Provider Business Mailing Address
First Line	:	2623 W CHICAGO AVE
Second Line	:	APT 2
City	:	CHICAGO
State	:	IL
Zip	:	60622-8180
Country	:	US
Telephone Number	:	574-993-7992
Fax Number	:

Provider Business Practice Location Address
First Line	:	1943 S MAY ST
Second Line	:	1F
City	:	CHICAGO
State	:	IL
Zip	:	60608-3359
Country	:	US
Telephone Number	:	312-579-8866
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	09/15/2020

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