Provider Demographics
NPI:1104367655
Name:BANIA, JULIA GRACE (WHNP-BC)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:GRACE
Last Name:BANIA
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16862 S OTTAWA DR
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-4373
Mailing Address - Country:US
Mailing Address - Phone:815-342-7616
Mailing Address - Fax:
Practice Address - Street 1:1890 SILVER CROSS BLVD
Practice Address - Street 2:#210
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-9524
Practice Address - Country:US
Practice Address - Phone:815-463-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.015765363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health