Provider Demographics
NPI:1245664077
Name:MARTIN, JULIANNE ELIZABETH (MS, RD, LD, CNSC)
Entity type:Individual
Prefix:MRS
First Name:JULIANNE
Middle Name:ELIZABETH
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MS, RD, LD, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2864 PARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SILVER LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44224-3727
Mailing Address - Country:US
Mailing Address - Phone:330-328-0387
Mailing Address - Fax:
Practice Address - Street 1:2864 PARKWOOD DR
Practice Address - Street 2:
Practice Address - City:SILVER LAKE
Practice Address - State:OH
Practice Address - Zip Code:44224-3727
Practice Address - Country:US
Practice Address - Phone:330-328-0387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6180133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered