Provider Demographics
NPI:1487795670
Name:DIMUCCI-WARD, JULISU (PHD, RD,CDE,LD)
Entity type:Individual
Prefix:DR
First Name:JULISU
Middle Name:
Last Name:DIMUCCI-WARD
Suffix:
Gender:F
Credentials:PHD, RD,CDE,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-3515
Mailing Address - Country:US
Mailing Address - Phone:864-327-9907
Mailing Address - Fax:864-804-6986
Practice Address - Street 1:350 HOWARD ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3515
Practice Address - Country:US
Practice Address - Phone:864-327-9907
Practice Address - Fax:864-804-6986
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
SC721719133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDT1016Medicaid
SCQ33593365Medicare PIN
SCQ407496066Medicare PIN
SCQ33593Medicare UPIN