Provider Demographics
NPI:1487207858
Name:JUEL, RYAN (MS, RDN, ACSM-CPT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:JUEL
Suffix:
Gender:F
Credentials:MS, RDN, ACSM-CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 W GRANT ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:PA
Mailing Address - Zip Code:15342-1427
Mailing Address - Country:US
Mailing Address - Phone:208-275-9699
Mailing Address - Fax:
Practice Address - Street 1:204 W GRANT ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:PA
Practice Address - Zip Code:15342-1427
Practice Address - Country:US
Practice Address - Phone:208-275-9699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
86105112OtherCOMMISSION ON DIETETIC REGISTRATION