Provider Demographics
NPI:1205187432
Name:DE PETRO, JULIE RENEE (MSN FNP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:RENEE
Last Name:DE PETRO
Suffix:
Gender:F
Credentials:MSN FNP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:RENEE
Other - Last Name:HOLLOWAY OR DEPETRO-KEYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, FNP
Mailing Address - Street 1:3333 CHESTER LN
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-1122
Mailing Address - Country:US
Mailing Address - Phone:661-809-9848
Mailing Address - Fax:
Practice Address - Street 1:3333 CHESTER LN
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309
Practice Address - Country:US
Practice Address - Phone:661-809-9848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14266363L00000X, 363LP2300X
CA468057 RN/ 14266 FNP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily