Provider Demographics
NPI:1396706404
Name:GAREY, JULIE (RD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:GAREY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:K
Other - Last Name:NICHOLLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:328 E BROADSTAIRS PL
Mailing Address - Street 2:APT D104
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-9775
Mailing Address - Country:US
Mailing Address - Phone:302-674-8579
Mailing Address - Fax:
Practice Address - Street 1:640 S STATE ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-3530
Practice Address - Country:US
Practice Address - Phone:302-744-6842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEDN-0000210133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE00B690S31Medicare ID - Type Unspecified
DE021098C49Medicare PIN