Provider Demographics
NPI:1326357369
Name:GOULANDRIS, JULIE M (CNP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:GOULANDRIS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7470 STONE RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-8931
Mailing Address - Country:US
Mailing Address - Phone:216-857-5786
Mailing Address - Fax:
Practice Address - Street 1:7470 STONE RD
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-8931
Practice Address - Country:US
Practice Address - Phone:216-857-5786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-24
Last Update Date:2011-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN219563-COA1163W00000X
OHCOA.11846-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH026440OtherMEDICARE PTAN