Basic Information
| Provider Information | |||||||||
| NPI: | 1184969230 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOORE | ||||||||
| FirstName: | JULIA | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | RD, LD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1760 ARLINGTON DR | ||||||||
| Address2: | |||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458051420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5672040166 | ||||||||
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| Practice Location | |||||||||
| Address1: | 770 W HIGH ST STE 400 | ||||||||
| Address2: | |||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458015917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192272727 | ||||||||
| FaxNumber: | 4192241589 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2012 | ||||||||
| LastUpdateDate: | 11/07/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | LD.7146 | OH | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.