Provider Demographics
NPI:1710198676
Name:ANDREONI, JULEEANNA (LD RD CDE)
Entity Type:Individual
Prefix:
First Name:JULEEANNA
Middle Name:
Last Name:ANDREONI
Suffix:
Gender:F
Credentials:LD RD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 SE KNAPP ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-6010
Mailing Address - Country:US
Mailing Address - Phone:503-308-8012
Mailing Address - Fax:833-407-9210
Practice Address - Street 1:1620 SE KNAPP ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-6010
Practice Address - Country:US
Practice Address - Phone:503-308-8012
Practice Address - Fax:833-407-9210
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR611133V00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500622902Medicaid