Provider Demographics
NPI:1184969230
Name:MOORE, JULIA ANN (RD, LD)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:ANN
Last Name:MOORE
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 ARLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-1420
Mailing Address - Country:US
Mailing Address - Phone:567-204-0166
Mailing Address - Fax:
Practice Address - Street 1:770 W HIGH ST STE 400
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-5917
Practice Address - Country:US
Practice Address - Phone:419-227-2727
Practice Address - Fax:419-224-1589
Is Sole Proprietor?:No
Enumeration Date:2012-11-30
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.7146133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered