Provider Demographics
NPI:1184247736
Name:WILSON, JULIEANNE CYHANIUK (REGISTERED DIETITIAN)
Entity type:Individual
Prefix:
First Name:JULIEANNE
Middle Name:CYHANIUK
Last Name:WILSON
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANNE
Other - Last Name:CYHANIUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10418 BOGARDUS AVE UNIT 2
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-2600
Mailing Address - Country:US
Mailing Address - Phone:909-731-2558
Mailing Address - Fax:
Practice Address - Street 1:12462 PUTNAM ST STE 3030
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-1048
Practice Address - Country:US
Practice Address - Phone:562-698-0811
Practice Address - Fax:562-789-4335
Is Sole Proprietor?:No
Enumeration Date:2020-05-18
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86079631133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered