Provider Demographics
NPI:1093008179
Name:SARAZINE, JULIA THERESE (ND)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:THERESE
Last Name:SARAZINE
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 W ADDISON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-3505
Mailing Address - Country:US
Mailing Address - Phone:773-248-4359
Mailing Address - Fax:773-248-4604
Practice Address - Street 1:1900 W POLK ST
Practice Address - Street 2:944
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3723
Practice Address - Country:US
Practice Address - Phone:312-864-4443
Practice Address - Fax:312-864-9500
Is Sole Proprietor?:No
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209001161363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily