Provider Demographics
NPI:1679904809
Name:BIPPERT, JULIA (RLD, CDE)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:BIPPERT
Suffix:
Gender:F
Credentials:RLD, CDE
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:
Other - Last Name:CANAVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RLD, CDE
Mailing Address - Street 1:8110 E 32ND ST N STE 125
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2644
Mailing Address - Country:US
Mailing Address - Phone:316-330-3636
Mailing Address - Fax:844-322-8797
Practice Address - Street 1:8110 E 32ND ST N STE 125
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2644
Practice Address - Country:US
Practice Address - Phone:316-330-3636
Practice Address - Fax:844-322-8797
Is Sole Proprietor?:No
Enumeration Date:2013-12-13
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1882133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered