Provider Demographics
NPI:1336656255
Name:WHELAN, JULIA (RDN/LD)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:WHELAN
Suffix:
Gender:F
Credentials:RDN/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1488 LANDAU RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-8275
Mailing Address - Country:US
Mailing Address - Phone:561-310-4659
Mailing Address - Fax:
Practice Address - Street 1:1488 LANDAU RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-8275
Practice Address - Country:US
Practice Address - Phone:561-310-4659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-30
Last Update Date:2017-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND7600133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered