Provider Demographics
NPI:1801594577
Name:LANDON, JULIANNE (RN)
Entity type:Individual
Prefix:
First Name:JULIANNE
Middle Name:
Last Name:LANDON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 N 750 E
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:UT
Mailing Address - Zip Code:84318-3366
Mailing Address - Country:US
Mailing Address - Phone:208-604-2039
Mailing Address - Fax:
Practice Address - Street 1:612 N 750 E
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:UT
Practice Address - Zip Code:84318-3366
Practice Address - Country:US
Practice Address - Phone:208-604-2039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5358802-3102163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn