Provider Demographics
NPI:1760634406
Name:JULIAN, DEIDRE ANN (DA)
Entity Type:Individual
Prefix:MS
First Name:DEIDRE
Middle Name:ANN
Last Name:JULIAN
Suffix:
Gender:F
Credentials:DA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:RI
Mailing Address - Zip Code:02885-3317
Mailing Address - Country:US
Mailing Address - Phone:401-864-0820
Mailing Address - Fax:
Practice Address - Street 1:18 BAKER ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:RI
Practice Address - Zip Code:02885-3102
Practice Address - Country:US
Practice Address - Phone:401-864-0820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDA00072171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist