Provider Demographics
NPI:1619452836
Name:FAIDLEY, JULIA K (RN, CNM)
Entity Type:Individual
Prefix:MS
First Name:JULIA
Middle Name:K
Last Name:FAIDLEY
Suffix:
Gender:F
Credentials:RN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 ELDRIDGE ST APT 10
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-1340
Mailing Address - Country:US
Mailing Address - Phone:646-644-9568
Mailing Address - Fax:
Practice Address - Street 1:237 ELDRIDGE ST APT 10
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-1340
Practice Address - Country:US
Practice Address - Phone:646-644-9568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001898176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY001898OtherMIDWIFERY LICENSE