Provider Demographics
NPI: | 1396211702 |
---|---|
Name: | MILITANTE, JULIUS (RN) |
Entity Type: | Individual |
Prefix: | |
First Name: | JULIUS |
Middle Name: | |
Last Name: | MILITANTE |
Suffix: | |
Gender: | M |
Credentials: | RN |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 28618 COUZENS AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | MADISON HEIGHTS |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 48071-2967 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 646-844-7471 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 28618 COUZENS AVE |
Practice Address - Street 2: | |
Practice Address - City: | MADISON HEIGHTS |
Practice Address - State: | MI |
Practice Address - Zip Code: | 48071-2967 |
Practice Address - Country: | US |
Practice Address - Phone: | 646-544-8471 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2018-10-23 |
Last Update Date: | 2021-08-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MI | 4704320054 | 163WC0400X, 163WH0200X, 163WM0705X, 163WG0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 163WG0000X | Nursing Service Providers | Registered Nurse | General Practice |
No | 163WC0400X | Nursing Service Providers | Registered Nurse | Case Management |
No | 163WH0200X | Nursing Service Providers | Registered Nurse | Home Health |
No | 163WM0705X | Nursing Service Providers | Registered Nurse | Medical-Surgical |