Provider Demographics
NPI:1457849697
Name:SHIMKO, JULIE (RD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:SHIMKO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:469 W SPAIN ST
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-5624
Mailing Address - Country:US
Mailing Address - Phone:773-603-1618
Mailing Address - Fax:
Practice Address - Street 1:1007B W COLLEGE AVE # 198
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-5029
Practice Address - Country:US
Practice Address - Phone:707-509-0226
Practice Address - Fax:844-322-4726
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86045793133N00000X, 133V00000X
133NN1002X, 133VN1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133VN1301XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Oncology