Basic Information
| Provider Information | |||||||||
| NPI: | 1922062173 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALBRECHT | ||||||||
| FirstName: | JULIE | ||||||||
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| Credential: | L.D.N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1040 SIERRA DR | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | GREENWOOD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461437240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3175284253 | ||||||||
| FaxNumber: | 3178658319 | ||||||||
| Practice Location | |||||||||
| Address1: | 3700 W 203RD ST STE 310 | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA FIELDS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604611182 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7086792717 | ||||||||
| FaxNumber: | 7086792260 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2006 | ||||||||
| LastUpdateDate: | 02/26/2019 | ||||||||
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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 | 164001207 | IL | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
ID Information
| ID | Type | State | Issuer | Description | IL5686053 | 01 | IL | MEDICARE PTAN | OTHER | 164001207 | 01 | IL | LICENSED DIETITIAN NUTRIT | OTHER | 460860 | 01 | IL | CDR REGISTRATION ID NUMBE | OTHER | 4673170001 | 01 | IL | DMERC | OTHER | DS3884 | 01 | IL | MEDICARE RAILROAD PTAN | OTHER |