Provider Demographics
NPI:1922326891
Name:IZSAK, JULIE AMY (MED,RD,LD)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:AMY
Last Name:IZSAK
Suffix:
Gender:F
Credentials:MED,RD,LD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:AMY
Other - Last Name:SUSSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3677
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03061-3677
Mailing Address - Country:US
Mailing Address - Phone:603-577-7900
Mailing Address - Fax:603-577-7972
Practice Address - Street 1:29 NORTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-4068
Practice Address - Country:US
Practice Address - Phone:603-577-3275
Practice Address - Fax:603-577-2432
Is Sole Proprietor?:No
Enumeration Date:2010-05-17
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0570133V00000X
NH0636133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered