Provider Demographics
NPI:1326478389
Name:DANIELSON, JULIE (RD LN)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:DANIELSON
Suffix:
Gender:F
Credentials:RD LN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 OLD HIGHWAY 12
Mailing Address - Street 2:
Mailing Address - City:ORTONVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56278-2142
Mailing Address - Country:US
Mailing Address - Phone:320-839-3258
Mailing Address - Fax:
Practice Address - Street 1:450 EASTVOLD AVE
Practice Address - Street 2:
Practice Address - City:ORTONVILLE
Practice Address - State:MN
Practice Address - Zip Code:56278-1252
Practice Address - Country:US
Practice Address - Phone:320-839-4018
Practice Address - Fax:320-839-2985
Is Sole Proprietor?:No
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1581133V00000X
SD0153133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered