Provider Demographics
NPI:1699275123
Name:BUMPUS, JULIA (RD)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:BUMPUS
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 1:10900 WORLD TRADE BLVD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-4202
Mailing Address - Country:US
Mailing Address - Phone:336-549-3034
Mailing Address - Fax:
Practice Address - Street 1:1821 MARTIN LUTHER KING PKWY
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6336
Practice Address - Country:US
Practice Address - Phone:919-748-4990
Practice Address - Fax:919-748-4991
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2018-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004438133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered