Provider Demographics
NPI:1508948373
Name:JULIAN, SUSAN B (CNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:B
Last Name:JULIAN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 E MAIN ST
Mailing Address - Street 2:PO BOX 205
Mailing Address - City:HAGERSTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47346-1212
Mailing Address - Country:US
Mailing Address - Phone:765-530-8008
Mailing Address - Fax:765-530-8099
Practice Address - Street 1:61 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:IN
Practice Address - Zip Code:47346-1212
Practice Address - Country:US
Practice Address - Phone:765-530-8008
Practice Address - Fax:765-530-8099
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001904A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
INQ39731Medicare UPIN
IN200510290Medicaid
IN136310NMedicare ID - Type Unspecified