Provider Demographics
NPI:1821561465
Name:FREE, JULIE (RDN/LDN)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:FREE
Suffix:
Gender:F
Credentials:RDN/LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 E INDIAN RD
Mailing Address - Street 2:
Mailing Address - City:NEWKIRK
Mailing Address - State:OK
Mailing Address - Zip Code:74647-7340
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:715 GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:PAWHUSKA
Practice Address - State:OK
Practice Address - Zip Code:74056-3201
Practice Address - Country:US
Practice Address - Phone:918-287-5525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKR080653797OtherDRIVER'S LICENSE