Provider Demographics
NPI:1780488916
Name:ALTAVILLA, JULIE
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:ALTAVILLA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1071 CHAMBERLIN RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3172
Mailing Address - Country:US
Mailing Address - Phone:412-849-1507
Mailing Address - Fax:
Practice Address - Street 1:1071 CHAMBERLIN RD
Practice Address - Street 2:
Practice Address - City:JEFFERSON HILLS
Practice Address - State:PA
Practice Address - Zip Code:15025-3172
Practice Address - Country:US
Practice Address - Phone:412-849-1507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAL-150796163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant