Provider Demographics
NPI:1396701892
Name:MCLAUGHLIN, JULIE A (MS, RD, CD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:MCLAUGHLIN
Suffix:
Gender:F
Credentials:MS, RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6633 N SOUTH 5TH ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53536-9705
Mailing Address - Country:US
Mailing Address - Phone:608-882-1210
Mailing Address - Fax:
Practice Address - Street 1:6633 N SOUTH 5TH ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:WI
Practice Address - Zip Code:53536-9705
Practice Address - Country:US
Practice Address - Phone:608-882-1210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-24
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI799-029133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
P05899Medicare UPIN
WIP00283454Medicare PIN