Provider Demographics
NPI:1053688978
Name:DOUGLAS, JULLIETTE JANERIO
Entity Type:Individual
Prefix:MISS
First Name:JULLIETTE
Middle Name:JANERIO
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 QUERVO LN
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:MO
Mailing Address - Zip Code:63052-1389
Mailing Address - Country:US
Mailing Address - Phone:636-287-9567
Mailing Address - Fax:636-287-1914
Practice Address - Street 1:3200 QUERVO LN
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:MO
Practice Address - Zip Code:63052-1389
Practice Address - Country:US
Practice Address - Phone:636-287-9567
Practice Address - Fax:636-287-1914
Is Sole Proprietor?:No
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider