Provider Demographics
NPI:1013490440
Name:ANDRECHUK, JULIA ANN
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:ANN
Last Name:ANDRECHUK
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 1:31 WESTBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-5309
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:31 WESTBRIDGE DR
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-5309
Practice Address - Country:US
Practice Address - Phone:631-495-8708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2022-04-12
Deactivation Date:2021-06-21
Deactivation Code:
Reactivation Date:2022-01-17
Provider Licenses
StateLicense IDTaxonomies
NY806035163W00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse