Provider Demographics
NPI:1851909154
Name:GOLDEN, JULISA JILLAINE
Entity Type:Individual
Prefix:
First Name:JULISA
Middle Name:JILLAINE
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3325 SE DIVISION ST APT 201
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1594
Mailing Address - Country:US
Mailing Address - Phone:503-473-1717
Mailing Address - Fax:
Practice Address - Street 1:1703 SW CLAY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-2528
Practice Address - Country:US
Practice Address - Phone:503-970-9554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula