Provider Demographics
NPI:1194908137
Name:MCMILLIN, JULIE ANN (RDLD)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANN
Last Name:MCMILLIN
Suffix:
Gender:F
Credentials:RDLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 N ANKENY BLVD
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-1753
Mailing Address - Country:US
Mailing Address - Phone:515-964-0900
Mailing Address - Fax:515-964-1384
Practice Address - Street 1:410 N ANKENY BLVD
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-1753
Practice Address - Country:US
Practice Address - Phone:515-964-0900
Practice Address - Fax:515-964-1384
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01548133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered