Provider Demographics
NPI:1275580177
Name:SKILLMAN, JULIANNE (RD)
Entity Type:Individual
Prefix:
First Name:JULIANNE
Middle Name:
Last Name:SKILLMAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:JULIANNE
Other - Middle Name:
Other - Last Name:VON FISCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:20055 FRANCE CIR
Mailing Address - Street 2:
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-9175
Mailing Address - Country:US
Mailing Address - Phone:952-469-1345
Mailing Address - Fax:
Practice Address - Street 1:559 CAPITOL BLVD
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55103-2101
Practice Address - Country:US
Practice Address - Phone:651-232-2000
Practice Address - Fax:651-232-2118
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1331133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered