Provider Demographics
NPI:1780989848
Name:TRYON, JULIA GRACE (CD(DONA))
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:GRACE
Last Name:TRYON
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5055 E 68TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-3926
Mailing Address - Country:US
Mailing Address - Phone:317-366-3982
Mailing Address - Fax:
Practice Address - Street 1:5055 E 68TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-3926
Practice Address - Country:US
Practice Address - Phone:317-366-3982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
99499OtherCPT CODE FOR EVALUATION AND MANAGEMENT SERVICES/LABOR SUPPOERT