Provider Demographics
NPI:1578290292
Name:SHOEMAKER, JULIA (RD)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:SHOEMAKER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:SHOEMKAER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:104 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:BLANDINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61420-9172
Mailing Address - Country:US
Mailing Address - Phone:309-333-8332
Mailing Address - Fax:
Practice Address - Street 1:104 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:BLANDINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:61420-9172
Practice Address - Country:US
Practice Address - Phone:309-333-8332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.008602133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered