Provider Demographics
NPI:1740737170
Name:BRANDT, JULIA (RD/LDN)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:BRANDT
Suffix:
Gender:F
Credentials:RD/LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 N KIRKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-2720
Mailing Address - Country:US
Mailing Address - Phone:314-807-9460
Mailing Address - Fax:
Practice Address - Street 1:720 N KIRKWOOD RD
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-2720
Practice Address - Country:US
Practice Address - Phone:314-807-9460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016003113133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered