Provider Demographics
NPI:1396869772
Name:BENNETT, JULIE ELIZABETH (RD)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ELIZABETH
Last Name:BENNETT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6898 40TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426-9218
Mailing Address - Country:US
Mailing Address - Phone:616-662-4429
Mailing Address - Fax:
Practice Address - Street 1:1838 BALDWIN ST
Practice Address - Street 2:
Practice Address - City:JENISON
Practice Address - State:MI
Practice Address - Zip Code:49428-8901
Practice Address - Country:US
Practice Address - Phone:616-667-4088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered