Provider Demographics
NPI:1639664477
Name:KRAEGER, JULIE L (FNP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:L
Last Name:KRAEGER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:L
Other - Last Name:EMERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5402 DAYAN ST
Mailing Address - Street 2:
Mailing Address - City:LOWVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13367-1100
Mailing Address - Country:US
Mailing Address - Phone:315-376-4600
Mailing Address - Fax:315-376-5587
Practice Address - Street 1:5402 DAYAN ST
Practice Address - Street 2:
Practice Address - City:LOWVILLE
Practice Address - State:NY
Practice Address - Zip Code:13367-1100
Practice Address - Country:US
Practice Address - Phone:315-376-4600
Practice Address - Fax:315-376-5587
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC00000363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner