Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | SP025085 | PA |
NPI | 1225795156 |
---|---|
Provider Name | Alexa Julian |
First Address | Philadelphia, PA 19102-1117 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2021 |
Last Update Date | 17/12/2021 |