MEDICARE: MRS. JULIANNE ELIZABETH MARTIN MS, RD, LD, CNSC

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	6180	OH

General Provider Information

NPI Number	:	1245664077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIANNE ELIZABETH MARTIN MS, RD, LD, CNSC

Provider Business Mailing Address
First Line	:	2864 PARKWOOD DR
Second Line	:
City	:	SILVER LAKE
State	:	OH
Zip	:	44224-3727
Country	:	US
Telephone Number	:	330-328-0387
Fax Number	:

Provider Business Practice Location Address
First Line	:	2864 PARKWOOD DR
Second Line	:
City	:	SILVER LAKE
State	:	OH
Zip	:	44224-3727
Country	:	US
Telephone Number	:	330-328-0387
Fax Number	:

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

Provider Enumeration Date	:	08/28/2013
Last Update Date	:	08/28/2013

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