Provider Demographics
NPI:1497062780
Name:JULIAN, MICHELLE DIMAIO (CRNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DIMAIO
Last Name:JULIAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 LEXINGTON DR
Mailing Address - Street 2:
Mailing Address - City:ANNVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17003-8631
Mailing Address - Country:US
Mailing Address - Phone:717-832-3257
Mailing Address - Fax:
Practice Address - Street 1:46 LEXINGTON DR
Practice Address - Street 2:
Practice Address - City:ANNVILLE
Practice Address - State:PA
Practice Address - Zip Code:17003-8631
Practice Address - Country:US
Practice Address - Phone:717-832-3257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP005793B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner