Provider Demographics
NPI:1891938247
Name:HAGAN, JULIANNE (RD, RN)
Entity Type:Individual
Prefix:
First Name:JULIANNE
Middle Name:
Last Name:HAGAN
Suffix:
Gender:F
Credentials:RD, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 WALNUT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-1211
Mailing Address - Country:US
Mailing Address - Phone:412-963-9298
Mailing Address - Fax:
Practice Address - Street 1:1386 OLD FREEPORT RD STE 3A
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-3115
Practice Address - Country:US
Practice Address - Phone:412-436-9219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-15
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN596540163W00000X
PADN000042133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No163W00000XNursing Service ProvidersRegistered Nurse