Provider Demographics
NPI:1124396213
Name:JUNGWIRTH, JULIE ANN (MS, RD, LD)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:ANN
Last Name:JUNGWIRTH
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 HIGH ST
Mailing Address - Street 2:APT 5
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3022
Mailing Address - Country:US
Mailing Address - Phone:865-441-0446
Mailing Address - Fax:
Practice Address - Street 1:452 OLD STREET RD
Practice Address - Street 2:
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458-1263
Practice Address - Country:US
Practice Address - Phone:603-924-4699
Practice Address - Fax:603-924-9586
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0609133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered