Provider Demographics
NPI:1942593140
Name:HOVENCAMP, JULIE (RDN, CDE)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:HOVENCAMP
Suffix:
Gender:F
Credentials:RDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 934
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-0934
Mailing Address - Country:US
Mailing Address - Phone:207-907-1187
Mailing Address - Fax:207-907-1189
Practice Address - Street 1:900 BROADWAY
Practice Address - Street 2:BLDG 3
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-1900
Practice Address - Country:US
Practice Address - Phone:207-907-1187
Practice Address - Fax:207-907-1189
Is Sole Proprietor?:No
Enumeration Date:2011-05-20
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDI1015133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered