Provider Demographics
NPI:1518396266
Name:JOHNSON, JULIE R
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:R
Last Name:JOHNSON
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 1:3075 COHASSET RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-0838
Mailing Address - Country:US
Mailing Address - Phone:530-636-6725
Mailing Address - Fax:
Practice Address - Street 1:3075 COHASSET RD
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-0838
Practice Address - Country:US
Practice Address - Phone:530-636-6725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA7817174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA7817OtherHEARING AID DISPENSER