Provider Demographics
NPI:1972903631
Name:COPE-EDWARDS, JULIAN (CNA)
Entity Type:Individual
Prefix:
First Name:JULIAN
Middle Name:
Last Name:COPE-EDWARDS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 PRISCILLA AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-3836
Mailing Address - Country:US
Mailing Address - Phone:631-369-8701
Mailing Address - Fax:631-369-8701
Practice Address - Street 1:178 PRISCILLA AVE
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-3836
Practice Address - Country:US
Practice Address - Phone:631-369-8701
Practice Address - Fax:631-369-8701
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-01
Last Update Date:2014-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY34240793036E376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide