Provider Demographics
NPI:1295029080
Name:BERNSTEIN, JULIE (RD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:BERNSTEIN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 CROOKED PUTTER DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5227
Mailing Address - Country:US
Mailing Address - Phone:702-622-5254
Mailing Address - Fax:
Practice Address - Street 1:158 CROOKED PUTTER DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5227
Practice Address - Country:US
Practice Address - Phone:702-622-5254
Practice Address - Fax:702-446-8343
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0955153133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV50240Medicare PIN