Provider Demographics
NPI:1033362892
Name:JULIUSSON, SUSAN N (APN)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:N
Last Name:JULIUSSON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 WOODMONT BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2245
Mailing Address - Country:US
Mailing Address - Phone:559-326-1222
Mailing Address - Fax:559-421-7004
Practice Address - Street 1:7130 N MILLBROOK AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3347
Practice Address - Country:US
Practice Address - Phone:559-326-1222
Practice Address - Fax:559-326-1225
Is Sole Proprietor?:No
Enumeration Date:2008-10-24
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-007241363LA2100X
IL209.007241363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL833120OtherMEDICARE GROUP PTAN
IL833120OtherMEDICARE GROUP PTAN