Provider Demographics
NPI:1558302687
Name:JULIANO, SUSAN A (CRNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:JULIANO
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 1:2301 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-4154
Mailing Address - Country:US
Mailing Address - Phone:717-397-2738
Mailing Address - Fax:
Practice Address - Street 1:2301 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-4154
Practice Address - Country:US
Practice Address - Phone:717-397-2738
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007627363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA067037Medicare ID - Type Unspecified
PAP80258Medicare UPIN