Provider Demographics
NPI:1760487839
Name:CASTRO, JULIANNA M (APN)
Entity Type:Individual
Prefix:
First Name:JULIANNA
Middle Name:M
Last Name:CASTRO
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5401 44TH AVENUE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-8126
Mailing Address - Country:US
Mailing Address - Phone:309-779-5670
Mailing Address - Fax:309-779-5675
Practice Address - Street 1:5401 44TH AVENUE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-8126
Practice Address - Country:US
Practice Address - Phone:309-779-5670
Practice Address - Fax:309-779-5675
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209-000723363LF0000X
IAA-083274363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
97792OtherWELLMARK BC/BS
64903OtherIOWA HEALTH SOLUTIONS
4796890024OtherDMERC
IL0113OtherJOHN DEERE HEALTH PLAN
ILP01371975OtherRR MEDICARE
048919OtherHEALTH ALLIANCE
97792OtherWELLMARK BC/BS
L86095Medicare PIN
ILF400166371Medicare PIN