Provider Demographics
NPI:1376016972
Name:CHANCELLOR, JULIA LYNN
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:LYNN
Last Name:CHANCELLOR
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 1:8275 WALNUT HILL LN APT 340
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4634
Mailing Address - Country:US
Mailing Address - Phone:503-453-6418
Mailing Address - Fax:
Practice Address - Street 1:8275 WALNUT HILL LN APT 340
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4634
Practice Address - Country:US
Practice Address - Phone:503-453-6418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX931468163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse