Provider Demographics
NPI:1710208228
Name:ANISIMOVA, JULIA (FNP-BC, RN)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:ANISIMOVA
Suffix:
Gender:F
Credentials:FNP-BC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33840 AURORA RD
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-3700
Mailing Address - Country:US
Mailing Address - Phone:440-284-5907
Mailing Address - Fax:440-248-1760
Practice Address - Street 1:33840 AURORA RD
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-3700
Practice Address - Country:US
Practice Address - Phone:440-284-5907
Practice Address - Fax:440-248-1760
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA11474-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily