Provider Demographics
NPI:1497265615
Name:PETRO, JULIANA M
Entity Type:Individual
Prefix:
First Name:JULIANA
Middle Name:M
Last Name:PETRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JULIANA
Other - Middle Name:M
Other - Last Name:PETRO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7323 E 31ST CT N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2212
Mailing Address - Country:US
Mailing Address - Phone:316-337-5873
Mailing Address - Fax:316-337-5873
Practice Address - Street 1:7323 E 31ST CT N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2212
Practice Address - Country:US
Practice Address - Phone:316-337-5873
Practice Address - Fax:316-337-5873
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2018-42938341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201168050AMedicaid