1922062173 NPI number — JULIE ALBRECHT L.D.N.

Table of content: (NPI 1629478391)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922062173 NPI number — JULIE ALBRECHT L.D.N.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALBRECHT
Provider First Name:
JULIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.D.N.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922062173
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1040 SIERRA DR
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
GREENWOOD
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46143-7240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-528-4253
Provider Business Mailing Address Fax Number:
317-865-8319

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3700 W 203RD ST STE 310
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLYMPIA FIELDS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60461-1182
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-679-2717
Provider Business Practice Location Address Fax Number:
708-679-2260
Provider Enumeration Date:
04/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  164001207 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: IL5686053 . This is a "MEDICARE PTAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 164001207 . This is a "LICENSED DIETITIAN NUTRIT" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 460860 . This is a "CDR REGISTRATION ID NUMBE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 4673170001 . This is a "DMERC" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: DS3884 . This is a "MEDICARE RAILROAD PTAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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