Provider Demographics
NPI:1598168478
Name:WORTHINGTON, JULIANE M
Entity Type:Individual
Prefix:
First Name:JULIANE
Middle Name:M
Last Name:WORTHINGTON
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 1:4228 PALMER RD
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-8735
Mailing Address - Country:US
Mailing Address - Phone:315-882-7610
Mailing Address - Fax:
Practice Address - Street 1:4228 PALMER RD
Practice Address - Street 2:
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104-8735
Practice Address - Country:US
Practice Address - Phone:315-882-7610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula