Provider Demographics
NPI:1649693037
Name:REODICA, JULIA L (RN, FNP-C)
Entity type:Individual
Prefix:MS
First Name:JULIA
Middle Name:L
Last Name:REODICA
Suffix:
Gender:F
Credentials:RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 SW GAINES ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-7403
Mailing Address - Country:US
Mailing Address - Phone:858-367-3672
Mailing Address - Fax:
Practice Address - Street 1:1012 SW GAINES ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-7403
Practice Address - Country:US
Practice Address - Phone:858-367-3672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN727268163W00000X
NY592944163W00000X
OR200943239RN163WC0200X
ORF1013361363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine