Provider Demographics
NPI:1922582295
Name:JULIEN, DANA BLOSSOM (J450135092554)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:BLOSSOM
Last Name:JULIEN
Suffix:
Gender:F
Credentials:J450135092554
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6122 OTIS ST
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1036
Mailing Address - Country:US
Mailing Address - Phone:202-705-0443
Mailing Address - Fax:
Practice Address - Street 1:1744 T ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-7101
Practice Address - Country:US
Practice Address - Phone:202-669-2682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDJ450135092554OtherMD DL
MDJ450135092554OtherMD DL