Provider Demographics
NPI:1093452120
Name:JEBRAN, JULIE ANN (RDN)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:JEBRAN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 TERRACE ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-5232
Mailing Address - Country:US
Mailing Address - Phone:610-597-1965
Mailing Address - Fax:
Practice Address - Street 1:3925 TERRACE ST UNIT 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-5232
Practice Address - Country:US
Practice Address - Phone:610-597-1965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN007340133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered