Provider Demographics
NPI:1467114827
Name:LOO, JULYNA LAWLAW
Entity Type:Individual
Prefix:
First Name:JULYNA
Middle Name:LAWLAW
Last Name:LOO
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 1:698 ORANGE AVE E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-1917
Mailing Address - Country:US
Mailing Address - Phone:651-428-8155
Mailing Address - Fax:
Practice Address - Street 1:122 W FRANKLIN AVE STE 510
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-2454
Practice Address - Country:US
Practice Address - Phone:612-913-1491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker