Provider Demographics
NPI:1215916515
Name:TRAINOR, JULIE ANNA (APRN)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANNA
Last Name:TRAINOR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:ANNA
Other - Last Name:WAKELY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:72 WHIP POOR WILL DR
Mailing Address - Street 2:
Mailing Address - City:MOOSUP
Mailing Address - State:CT
Mailing Address - Zip Code:06354-1728
Mailing Address - Country:US
Mailing Address - Phone:860-428-4784
Mailing Address - Fax:
Practice Address - Street 1:148 E 38TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-2607
Practice Address - Country:US
Practice Address - Phone:860-230-0020
Practice Address - Fax:833-955-3592
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003280363LF0000X
NY1043889967261QM2500X
CT1992372403261QM2500X
NJ1992372403261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTQ56160Medicare UPIN
CT500001578Medicare ID - Type Unspecified