Provider Demographics
NPI:1699172932
Name:COYNE, JULIA (RD, LN, IBCLC)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:COYNE
Suffix:
Gender:F
Credentials:RD, LN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2616 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-5029
Mailing Address - Country:US
Mailing Address - Phone:406-490-2426
Mailing Address - Fax:
Practice Address - Street 1:2616 LOCUST ST
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-5029
Practice Address - Country:US
Practice Address - Phone:406-490-2426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT956717133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist