Provider Demographics
NPI:1740430131
Name:WASHBURN, JULIANE SUE (RD)
Entity Type:Individual
Prefix:MS
First Name:JULIANE
Middle Name:SUE
Last Name:WASHBURN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:JULIANE
Other - Middle Name:SUE
Other - Last Name:ORTLIEB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:811 KENNEDY CT
Mailing Address - Street 2:
Mailing Address - City:PESHTIGO
Mailing Address - State:WI
Mailing Address - Zip Code:54157-1026
Mailing Address - Country:US
Mailing Address - Phone:715-582-4912
Mailing Address - Fax:
Practice Address - Street 1:3100 SHORE DR
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-4242
Practice Address - Country:US
Practice Address - Phone:715-735-4200
Practice Address - Fax:715-735-8017
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI422029133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI70020510000038611482Medicare PIN