Provider Demographics
NPI:1336992809
Name:CARVER, JULIE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:CARVER
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 1:607 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-3135
Mailing Address - Country:US
Mailing Address - Phone:937-389-1571
Mailing Address - Fax:
Practice Address - Street 1:111 PIKE ST
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-2101
Practice Address - Country:US
Practice Address - Phone:937-422-7659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0359544Medicaid