Provider Demographics
NPI:1285629394
Name:SULE, ULKA D (RD, CDE)
Entity type:Individual
Prefix:MRS
First Name:ULKA
Middle Name:D
Last Name:SULE
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 JEFFERSON OAKS DR
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-7066
Mailing Address - Country:US
Mailing Address - Phone:318-255-2435
Mailing Address - Fax:
Practice Address - Street 1:ST. FRANCIS MEDICAL CENTER
Practice Address - Street 2:309 JACKSON ST
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201
Practice Address - Country:US
Practice Address - Phone:318-327-4072
Practice Address - Fax:318-327-4941
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA133V00000XMedicare ID - Type UnspecifiedREGISTERED DIETITIAN
LA133N00000XMedicare ID - Type UnspecifiedNUTRITIONIST
LA133NN1002XMedicare ID - Type UnspecifiedNUTRITION EDUCATION
LA133VN1004XMedicare ID - Type UnspecifiedPEDIATRIC NUTRITION
LA133VN1005XMedicare ID - Type UnspecifiedRENAL NUTRITION