Provider Demographics
NPI:1720663610
Name:MURRAY, JOLEEN ELIZABETH (RDN)
Entity Type:Individual
Prefix:MRS
First Name:JOLEEN
Middle Name:ELIZABETH
Last Name:MURRAY
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 IL 185
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62471-3437
Mailing Address - Country:US
Mailing Address - Phone:618-267-3012
Mailing Address - Fax:
Practice Address - Street 1:427 IL 185
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:IL
Practice Address - Zip Code:62471-3437
Practice Address - Country:US
Practice Address - Phone:618-267-3012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164008288133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered