Provider Demographics
NPI:1518409861
Name:DEIGNAN, JULIE (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:DEIGNAN
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10650 ALYSSUM LN
Mailing Address - Street 2:APT 106
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93004-4850
Mailing Address - Country:US
Mailing Address - Phone:502-338-5893
Mailing Address - Fax:
Practice Address - Street 1:25115 AVENUE STANFORD
Practice Address - Street 2:SUITE A-104
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-1290
Practice Address - Country:US
Practice Address - Phone:661-257-2339
Practice Address - Fax:661-257-2384
Is Sole Proprietor?:No
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005401363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily