Provider Demographics
NPI:1922062173
Name:ALBRECHT, JULIE (LDN)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:ALBRECHT
Suffix:
Gender:F
Credentials:LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 SIERRA DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-7240
Mailing Address - Country:US
Mailing Address - Phone:317-528-4253
Mailing Address - Fax:317-865-8319
Practice Address - Street 1:3700 W 203RD ST STE 310
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1182
Practice Address - Country:US
Practice Address - Phone:708-679-2717
Practice Address - Fax:708-679-2260
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164001207133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL5686053OtherMEDICARE PTAN
IL164001207OtherLICENSED DIETITIAN NUTRIT
IL460860OtherCDR REGISTRATION ID NUMBE
IL4673170001OtherDMERC
ILDS3884OtherMEDICARE RAILROAD PTAN
IL4673170001OtherDMERC