Provider Demographics
NPI:1770686263
Name:CONNER, JULIE CAROLINE (PHD, RD, CDN)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:CAROLINE
Last Name:CONNER
Suffix:
Gender:F
Credentials:PHD, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 FEDERAL RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-2406
Mailing Address - Country:US
Mailing Address - Phone:203-775-1819
Mailing Address - Fax:203-775-2028
Practice Address - Street 1:366 FEDERAL ROAD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-2406
Practice Address - Country:US
Practice Address - Phone:203-775-1819
Practice Address - Fax:203-775-2028
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0000025133V00000X
NY000048-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT710000029Medicare ID - Type Unspecified