Provider Demographics
NPI:1659913622
Name:APPOLONIA, JULIE FONTAINE (DTR)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:FONTAINE
Last Name:APPOLONIA
Suffix:
Gender:F
Credentials:DTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY DRIVE C, MAIL STOP 120 NF-U
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15240
Mailing Address - Country:US
Mailing Address - Phone:412-360-1184
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY DRIVE C, MAIL STOP 120 NF-U
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15240
Practice Address - Country:US
Practice Address - Phone:412-360-1184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86021665136A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered