Provider Demographics
NPI:1356619274
Name:DEDRICKSON, JULIA E
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:E
Last Name:DEDRICKSON
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 1:5721 SCARBOROUGH LN
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34241-5436
Mailing Address - Country:US
Mailing Address - Phone:918-574-4885
Mailing Address - Fax:
Practice Address - Street 1:5721 SCARBOROUGH LN
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34241-5436
Practice Address - Country:US
Practice Address - Phone:918-574-4885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2016-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other