Provider Demographics
NPI:1033569934
Name:DESRAVINES, JULIENNE FLORIVAL (RDN LDN)
Entity Type:Individual
Prefix:
First Name:JULIENNE
Middle Name:FLORIVAL
Last Name:DESRAVINES
Suffix:
Gender:F
Credentials:RDN LDN
Other - Prefix:
Other - First Name:JULIENNE
Other - Middle Name:
Other - Last Name:FLORIVAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:113 WILLIAMS RD
Mailing Address - Street 2:
Mailing Address - City:ASHBURNHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01430-1664
Mailing Address - Country:US
Mailing Address - Phone:857-246-0911
Mailing Address - Fax:
Practice Address - Street 1:113 WILLIAMS RD
Practice Address - Street 2:
Practice Address - City:ASHBURNHAM
Practice Address - State:MA
Practice Address - Zip Code:01430
Practice Address - Country:US
Practice Address - Phone:857-246-0911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-21
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2304133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist