Provider Demographics
NPI:1851792428
Name:MUTTER, JULIA (RD, LDN)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:MUTTER
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 1:4364 MORNINGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-2829
Mailing Address - Country:US
Mailing Address - Phone:202-437-0641
Mailing Address - Fax:
Practice Address - Street 1:4364 MORNINGWOOD DR
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-2829
Practice Address - Country:US
Practice Address - Phone:202-437-0641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-14
Last Update Date:2014-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD02310133V00000X
DCDI100000110133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered